Provider Demographics
NPI:1790925410
Name:WIDMAYER, ASHLEY NICOLE (MA, LPC, CSAC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:NICOLE
Last Name:WIDMAYER
Suffix:
Gender:F
Credentials:MA, LPC, CSAC
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:NICOLE
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC, CSAC
Mailing Address - Street 1:777 NORTH JEFFERSON STREET
Mailing Address - Street 2:SUITE 408 #1184
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202
Mailing Address - Country:US
Mailing Address - Phone:414-710-5848
Mailing Address - Fax:
Practice Address - Street 1:777 NORTH JEFFERSON STREET
Practice Address - Street 2:SUITE 408 #1184
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202
Practice Address - Country:US
Practice Address - Phone:414-710-5848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-21
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15547-132101YA0400X
WI4772-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1790925410Medicaid