Organization
BROTOLOC INC. OUTPATIENT CLINIC
Active
Other names
Brotoloc
Organization subpart
No
Provider details
NPI number
Authorized official
GARY S JOHNSON (VICE PRESIDENT)
(262) 473-0480
Entity
Organization
Contact information
Practice address
209 S TAFT ST, WHITEWATER, WI 53190-2139
(262) 473-0480
(262) 473-0486
Mailing address
209 S TAFT ST, WHITEWATER, WI 53190-2139
(262) 473-0480
(262) 473-0486
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1115
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42181100
—
WI
Enumeration date
04/19/2007
Last updated
08/22/2020
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