| Organization Name: | BROTOLOC INC. OUTPATIENT CLINIC |
| NPI Number: | 1184841660 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GARY S JOHNSON (VICE PRESIDENT) |
| Mailing Address: | 209 S Taft St Whitewater |
| State: | WI US |
| Postal Code: | 531902139 |
| Phone Number: | 2624730480 |
| Fax Number: | 2624730486 |
| NPI Enumeration Date: | 04/19/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 1115 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |