MEDICARE: DR. SARA M HEGERTY PH.D.

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	103TC0700X	Clinical Psychologist	3240	WI
2	103T00000X	Psychologist

General Provider Information

NPI Number	:	1912133729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARA M HEGERTY PH.D.

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	:	716-289-7459
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2009
Last Update Date	:	10/31/2022

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