| Brotoloc | |
|
209 S Taft St Whitewater WI 53190-2139 | |
| (262) 473-0480 | |
| (262) 473-0486 |
| Full Name | Brotoloc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 209 S Taft St, Whitewater, Wisconsin |
| Authorized Official Name and Position | Gary S Johnson (VICE PRESIDENT) |
| Authorized Official Contact | 2624730480 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Brotoloc 209 S Taft St Whitewater WI 53190-2139 Ph: (262) 473-0480 | Brotoloc 209 S Taft St Whitewater WI 53190-2139 Ph: (262) 473-0480 |
| NPI Number | 1184841660 |
|---|---|
| Provider Enumeration Date | 04/19/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184841660 | NPI | - | NPPES |
| 42181100 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 1115 (Wisconsin) | Primary |
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