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NPI Code Detail

MEDICARE: ASHLEY WILD

MEDICARE: ASHLEY WILD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker255813KY

General Provider Information

NPI Number : 1447969068
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASHLEY WILD
Provider Business Mailing Address
First Line : 220 CEDAR ST APT 102
Second Line :
City : LEXINGTON
State : KY
Zip : 40508-2986
Country : US
Telephone Number : 618-357-1526
Fax Number :
Provider Business Practice Location Address
First Line : 3147 CUSTER DR
Second Line :
City : LEXINGTON
State : KY
Zip : 40517-4020
Country : US
Telephone Number : 859-447-0855
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/22/2022
Last Update Date : 11/22/2022

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Directions to “ ASHLEY WILD ” Practice Location

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