Individual
RUSSELL WIESTON BRETHAUER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYD.
Contact information
Practice address
700 PILGRIM PKWY, SUITE 201, ELM GROVE, WI 53122-2063
(262) 785-5557
(262) 785-5586
Mailing address
700 PILGRIM PKWY, SUITE 201, ELM GROVE, WI 53122-2063
(262) 785-5557
(262) 785-5586
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
983
WI
106H00000X
Marriage & Family Therapist
185
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39027200
—
WI
Enumeration date
05/19/2006
Last updated
10/18/2007
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