Provider Demographics
NPI:1821199944
Name:HESS, MARY VIRGINIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:VIRGINIA
Last Name:HESS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:VIRGINIA
Other - Last Name:ZAHM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1570 E MORELAND BLVD
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-3913
Mailing Address - Country:US
Mailing Address - Phone:262-544-9622
Mailing Address - Fax:262-522-3681
Practice Address - Street 1:1570 E MORELAND BLVD
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-3913
Practice Address - Country:US
Practice Address - Phone:262-544-9622
Practice Address - Fax:262-522-3681
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2304-057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39278400Medicaid
WIP38654Medicare UPIN