MEDICARE: HEGERTY PSYCHOLOGICAL SERVICES LLC

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
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1134836034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEGERTY PSYCHOLOGICAL SERVICES LLC

Provider Business Mailing Address
First Line	:	1915 E KENWOOD BLVD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-3007
Country	:	US
Telephone Number	:	716-289-7459
Fax Number	:

Provider Business Practice Location Address
First Line	:	1915 E KENWOOD BLVD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-3007
Country	:	US
Telephone Number	:	414-253-3256
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST/OWNER
Name	:	DR. SARA HEGERTY
Credential	:	PHD
Telephone Number	:	716-289-7459

Provider Enumeration Date	:	10/31/2022
Last Update Date	:	10/31/2022

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