Provider Demographics
NPI:1235859547
Name:WILDER, AMBRESHA STEPHANIE (SOCIAL WORKER)
Entity Type:Individual
Prefix:
First Name:AMBRESHA
Middle Name:STEPHANIE
Last Name:WILDER
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 ALMEDA RD APT 9306
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-4342
Mailing Address - Country:US
Mailing Address - Phone:619-359-9336
Mailing Address - Fax:
Practice Address - Street 1:12337 JONES RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4800
Practice Address - Country:US
Practice Address - Phone:903-345-4545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX41289483OtherDRIVERS LICENSE