Provider Demographics
NPI:1790925410
Name:WIDMAYER, ASHLEY NICOLE (MA, LPC, CSAC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:NICOLE
Last Name:WIDMAYER
Suffix:
Gender:F
Credentials:MA, LPC, CSAC
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:NICOLE
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC, CSAC
Mailing Address - Street 1:229 E WISCONSIN AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-4230
Mailing Address - Country:US
Mailing Address - Phone:414-224-3737
Mailing Address - Fax:414-224-3725
Practice Address - Street 1:229 E WISCONSIN AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-4230
Practice Address - Country:US
Practice Address - Phone:414-224-3737
Practice Address - Fax:414-224-3725
Is Sole Proprietor?:No
Enumeration Date:2009-02-21
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4772-125101YP2500X
WI15547-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1790925410Medicaid