Provider Demographics
NPI:1205687647
Name:WIMBLEY, ASHLEY (CEO)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:WIMBLEY
Suffix:
Gender:F
Credentials:CEO
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:WIMBLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CEO & FOUNDER
Mailing Address - Street 1:2321 TAYLOR PARK DR STE 1110
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-8052
Mailing Address - Country:US
Mailing Address - Phone:614-706-0603
Mailing Address - Fax:
Practice Address - Street 1:798 PRESTON TRAIL DRIVE
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147
Practice Address - Country:US
Practice Address - Phone:614-706-0603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator