Brotoloc Inc. Outpatient Clinic
Organization Active NPI Clinical Psychologist · Whitewater, WI
NPI 1184841660 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1184841660
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 1115 (WI)
- Legal business name
- BROTOLOC INC. OUTPATIENT CLINIC
- Practice address
- 209 S Taft St
Whitewater, WI 53190-2139 - Phone
- (262) 473-0480
- Fax
- (262) 473-0486
- NPI assigned
- Apr 19, 2007
- Organization subpart
- No
Authorized official
- Name
- Gary S Johnson
- Title
- Vice President
- Phone
- (262) 473-0480
Corporate family (same tax ID) 5
National Provider Directory
- Tax ID family
- Brotoloc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist |
103TC0700X | 1115 | WI | Yes |
Addresses
Primary practice location
209 S Taft St
Whitewater, WI 53190-2139
Mailing address
209 S Taft St
Whitewater, WI 53190-2139
Phone (262) 473-0480
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 42181100 | Medicaid | WI |
Other names
- Brotoloc
Other providers in Whitewater, WI
- Mikayla Lynn Boettner
- Lisa K Brellenthin
- Cheryl Bresnahan
- Forrest Lee Bright
- Patricia Lee Bromley
- Brotoloc Inc. Outpatient Clinic
- Brotoloc South, Inc.
- Brotoloc South, Inc.
- Maria Ann Brown
- Laura B Carney
All providers in Whitewater, WI · Clinical Psychologist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.