MEDICARE: ASHLEY SATARA NICOLE WILDER CDCA

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	182497	OH

General Provider Information

NPI Number	:	1942067657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY SATARA NICOLE WILDER CDCA

Provider Business Mailing Address
First Line	:	3218 SELDEN AVE
Second Line	:
City	:	MIDDLETOWN
State	:	OH
Zip	:	45044-6446
Country	:	US
Telephone Number	:	513-915-3311
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 TRIANGLE PARK DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45246-3423
Country	:	US
Telephone Number	:	513-915-3311
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/29/2024
Last Update Date	:	02/29/2024

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