MEDICARE: ASPEN PSYCHOLOGY 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	251S00000X	Community/Behavioral Health Agency	2956-57	WI

General Provider Information

NPI Number	:	1891051363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASPEN PSYCHOLOGY LLC

Provider Business Mailing Address
First Line	:	2131 S WEBSTER AVE
Second Line	:	SUITE 105
City	:	GREEN BAY
State	:	WI
Zip	:	54301-2288
Country	:	US
Telephone Number	:	920-544-6712
Fax Number	:	920-372-1380

Provider Business Practice Location Address
First Line	:	2131 S WEBSTER AVE
Second Line	:	SUITE 105
City	:	GREEN BAY
State	:	WI
Zip	:	54301-2288
Country	:	US
Telephone Number	:	920-544-6712
Fax Number	:	920-372-1380

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	DR. HEIDI ANN BEMOWSKI
Credential	:	PH.D.
Telephone Number	:	920-544-6712

Provider Enumeration Date	:	04/09/2012
Last Update Date	:	04/09/2012

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