Organization
BROTOLOC OUTPATIENT CLINIC
Active
Other names
Brotoloc
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS SVEDA MSW (DIRECTOR)
(414) 543-3200
Entity
Organization
Contact information
Practice address
5812 W BURNHAM ST, WEST ALLIS, WI 53219-1524
(414) 543-3200
(414) 543-3269
Mailing address
5812 WEST BURNHAM STREET, WEST ALLIS, WI 53219
(414) 543-3200
(414) 543-3269
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
1114
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42207400
—
WI
Enumeration date
02/13/2007
Last updated
08/22/2020
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