Provider Demographics
NPI:1235859547
Name:WILDER, AMBRESHA STEPHANIE (SOCIAL WORKER)
Entity type:Individual
Prefix:
First Name:AMBRESHA
Middle Name:STEPHANIE
Last Name:WILDER
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5330 SIENNA PKWY APT 1205
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-3783
Mailing Address - Country:US
Mailing Address - Phone:619-753-5237
Mailing Address - Fax:
Practice Address - Street 1:5330 SIENNA PKWY
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-7413
Practice Address - Country:US
Practice Address - Phone:832-795-4384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2025-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1094591041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX41289483OtherDRIVERS LICENSE