| Brotoloc | |
|
3917 47th Ave Kenosha WI 53144-1956 | |
| (262) 656-9975 | |
| (262) 656-9974 |
| Full Name | Brotoloc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 3917 47th Ave, Kenosha, Wisconsin |
| Authorized Official Name and Position | Melanie Barbeaux-stinson (DIRECTOR) |
| Authorized Official Contact | 2626569975 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Brotoloc 3917 47th Ave Kenosha WI 53144-1956 Ph: (262) 656-9975 | Brotoloc 3917 47th Ave Kenosha WI 53144-1956 Ph: (262) 656-9975 |
| NPI Number | 1629111943 |
|---|---|
| Provider Enumeration Date | 02/15/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629111943 | NPI | - | NPPES |
| 42242400 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 2605 (Wisconsin) | Primary |
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