Provider Demographics
NPI:1891051363
Name:ASPEN PSYCHOLOGY LLC
Entity Type:Organization
Organization Name:ASPEN PSYCHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BEMOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:920-544-6712
Mailing Address - Street 1:2131 S WEBSTER AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-2288
Mailing Address - Country:US
Mailing Address - Phone:920-544-6712
Mailing Address - Fax:920-372-1380
Practice Address - Street 1:2131 S WEBSTER AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-2288
Practice Address - Country:US
Practice Address - Phone:920-544-6712
Practice Address - Fax:920-372-1380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2956-57251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health