Provider Demographics
NPI:1124900782
Name:WIEDEBUSCH, ASHTEN MARIE (LMSW)
Entity type:Individual
Prefix:
First Name:ASHTEN
Middle Name:MARIE
Last Name:WIEDEBUSCH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 COLLEGE PARK DR APT 165
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-6494
Mailing Address - Country:US
Mailing Address - Phone:940-507-0807
Mailing Address - Fax:
Practice Address - Street 1:114 N WACO ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-3232
Practice Address - Country:US
Practice Address - Phone:817-594-3052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109263104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker