Brethauer, Russell Wieston

Brethauer, Russell Wieston is an sole proprietor health care provider with primary practice located at 700 Pilgrim Pkwy Suite 201, Elm Grove WI 53122-2063. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Marriage & Family Therapist. Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Brethauer, Russell Wieston can be contacted via phone (262) 785-5557.

Contact Information

Primary practice address
700 Pilgrim Pkwy Suite 201 Elm Grove WI 53122-2063
Phone: (262) 785-5557
Fax: (262) 785-5586
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 983 Wisconsin
Behavioral Health & Social Service Providers / Marriage & Family Therapist 106H00000X 185 Wisconsin

Profile Details

NPI number 1023062528
LBN Legal business name Brethauer, Russell Wieston
Credentials PSYD.
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 19th, 2006
Last updated Oct 18th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1023062528 NPPES
Wisconsin MEDICAID 39027200

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