Brotoloc Outpatient Clinic
Organization Active NPI Mental Health Clinic/Center (Including Community Mental Health Center) · West Allis, WI
NPI 1700928017 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1700928017
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
- License
- 1114 (WI)
- Legal business name
- BROTOLOC OUTPATIENT CLINIC
- Practice address
- 5812 W Burnham St
West Allis, WI 53219-1524 - Phone
- (414) 543-3200
- Fax
- (414) 543-3269
- NPI assigned
- Feb 13, 2007
- Organization subpart
- No
Authorized official
- Name
- Douglas Sveda, MSW
- Title
- Director
- Phone
- (414) 543-3200
Corporate family (same tax ID) 5
Practitioners 5
-
Cassandra Braam, PH.D.
-
Steven John Braam, PH.D.
-
Gerald Allan Theis, M.S.W.
-
Terence Young, PSY.D.
National Provider Directory
- Tax ID family
- Brotoloc
Locations
7330 W Layton Ave
Ste 200
Greenfield, WI 53220
Phone (414) 817-8330
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | 1114 | WI | Yes |
Addresses
Primary practice location
5812 W Burnham St
West Allis, WI 53219-1524
Mailing address
5812 West Burnham Street
West Allis, WI 53219
Phone (414) 543-3200
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 42207400 | Medicaid | WI |
Other names
- Brotoloc
Other providers in West Allis, WI
- Michael F Briselli
- Alejandrina Brito
- Kelly Britton
- Broadstep-Wisconsin, Inc.
- Emily Marie Bronikowski
- Brotoloc Sesmv
- Brotoloc South, Inc.
- Brotoloc South, Inc.
- Eboney Brown
- Jessica Brown
All providers in West Allis, WI · Mental Health Clinic/Center (Including Community Mental Health Center) 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.