Healthcare Provider Details

I. General information

NPI: 1083168918
Provider Name (Legal Business Name): ASHLEY WISDOM M. ED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2016
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2405 PALMER CIR STE 100
NORMAN OK
73069-6351
US

IV. Provider business mailing address

1401 N MCMILLAN AVE
OKLAHOMA CITY OK
73127-3048
US

V. Phone/Fax

Practice location:
  • Phone: 405-561-7928
  • Fax:
Mailing address:
  • Phone: 405-824-5553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: