Provider Demographics
NPI:1336569714
Name:WILDASIN, ASHLEY
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:
Last Name:WILDASIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2275 WATER GARDEN DR
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-8322
Mailing Address - Country:US
Mailing Address - Phone:717-451-7849
Mailing Address - Fax:
Practice Address - Street 1:37 LEFEVER ST
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-2603
Practice Address - Country:US
Practice Address - Phone:717-334-6254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-23
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC0096291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical