Provider Demographics
NPI:1003192881
Name:WIEDENMEYER, ASHLEY HEINTZELMAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:HEINTZELMAN
Last Name:WIEDENMEYER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7507 SAGAMORE RD
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-3613
Mailing Address - Country:US
Mailing Address - Phone:913-488-6288
Mailing Address - Fax:
Practice Address - Street 1:7507 SAGAMORE RD
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-3613
Practice Address - Country:US
Practice Address - Phone:913-488-6288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSPOST-DOC SUPERVISEE103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling