Provider Demographics
NPI:1699938605
Name:WILSON, ASHLEY RENEE (LMSW)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:RENEE
Last Name:WILSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22214 D ST
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67156-7376
Mailing Address - Country:US
Mailing Address - Phone:620-442-4540
Mailing Address - Fax:620-442-4559
Practice Address - Street 1:22214 D ST
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156-7376
Practice Address - Country:US
Practice Address - Phone:620-442-4540
Practice Address - Fax:620-442-4559
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7167104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker