Provider Demographics
NPI:1841590684
Name:WIBERG, ASHLEY (MSW)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:
Last Name:WIBERG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55-690 WAHINEPEE ST. C
Mailing Address - Street 2:
Mailing Address - City:LAIE
Mailing Address - State:WA
Mailing Address - Zip Code:96762
Mailing Address - Country:US
Mailing Address - Phone:509-551-2750
Mailing Address - Fax:
Practice Address - Street 1:56-660 KAMEHAMEHA HWY
Practice Address - Street 2:
Practice Address - City:KAHUKU
Practice Address - State:HI
Practice Address - Zip Code:96731-2210
Practice Address - Country:US
Practice Address - Phone:808-293-7555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)