| Wieland Associates, Inc. | |
|
1415 Magnavox Way Ste: 120 Fort Wayne IN 46804-1553 | |
| (260) 483-7207 | |
| (260) 483-0836 |
| Full Name | Wieland Associates, Inc. |
|---|---|
| Speciality | Psychologist |
| Location | 1415 Magnavox Way, Fort Wayne, Indiana |
| Authorized Official Name and Position | Kevin Lee Wieland (PRESIDENT/PSYCHOLOGIST) |
| Authorized Official Contact | 2604837207 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wieland Associates, Inc. 1415 Magnavox Way Ste:120 Fort Wayne IN 46804-1553 Ph: (260) 483-7207 | Wieland Associates, Inc. 1415 Magnavox Way Ste: 120 Fort Wayne IN 46804-1553 Ph: (260) 483-7207 |
| NPI Number | 1356547962 |
|---|---|
| Provider Enumeration Date | 06/21/2007 |
| Last Update Date | 10/28/2016 |
| Medicare PECOS PAC ID | 7618948266 |
|---|---|
| Medicare Enrollment ID | O20040805000608 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356547962 | NPI | - | NPPES |
| 200260310A | Medicaid | IN | |
| 200360310A | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (Indiana) | Primary |
| 103TC0700X | Psychologist - Clinical | 20041419A (Indiana) | Secondary |
| Provider Name | Kevin Lee Wieland |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1497737902 PECOS PAC ID: 9133190788 Enrollment ID: I20060103000490 |
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