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NPI Code Detail

MEDICARE: MARY HEGEMAN LPC-IT

MEDICARE: MARY HEGEMAN LPC-IT
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
1101YP2500XProfessional Counselor7914226WI

General Provider Information

NPI Number : 1356185003
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY HEGEMAN LPC-IT
Provider Business Mailing Address
First Line : 4223 AUTUMN CT APT E206
Second Line :
City : SHEBOYGAN
State : WI
Zip : 53081-1256
Country : US
Telephone Number : 920-650-4741
Fax Number :
Provider Business Practice Location Address
First Line : 503 WISCONSIN AVE
Second Line :
City : SHEBOYGAN
State : WI
Zip : 53081-4147
Country : US
Telephone Number : 920-650-4741
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2024
Last Update Date : 07/22/2024

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Directions to “ MARY HEGEMAN LPC-IT” Practice Location

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