Provider Demographics
NPI:1912133729
Name:HEGERTY, SARA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:M
Last Name:HEGERTY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:ANN
Other - Last Name:MURRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1915 E KENWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-3007
Mailing Address - Country:US
Mailing Address - Phone:716-289-7459
Mailing Address - Fax:
Practice Address - Street 1:1915 E KENWOOD BLVD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-3007
Practice Address - Country:US
Practice Address - Phone:716-289-7459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3240103TC0700X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical