Individual
ROBERT ANTHONY BOTTALLA JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7101 N GREEN BAY AVE, GLENDALE, WI 53209-2800
(414) 288-6187
Mailing address
405 BISHOPS WAY UNIT 633, BROOKFIELD, WI 53005-6261
(847) 899-7653
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1463-140
WI
Other
Enumeration date
04/15/2022
Last updated
12/01/2025
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