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General NPI Number Information
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NPI Number | 1134836034
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Entity Type | Organization
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Legal Business Name | HEGERTY PSYCHOLOGICAL SERVICES LLC
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Dates
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Enumeration Date | 10/31/2022
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Last Update Date | 10/31/2022
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Provider Practice Location Address
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Address Line | 1915 E KENWOOD BLVD
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City | MILWAUKEE
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State | WI
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Zip | 53211-3007
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Country | US
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Telephone | 414-253-3256
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Fax |
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Provider Business Mailing Address
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Address Line | 1915 E KENWOOD BLVD
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City | MILWAUKEE
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State | WI
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Zip | 53211-3007
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Country | US
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Telephone | 716-289-7459
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST/OWNER
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Name | DR. SARA HEGERTY
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Credential | PHD
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Telephone | 716-289-7459
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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