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Contact Information

RUSSELL W BRETHAUER, PSYD.
700 PILGRIM PKWY
SUITE 201
ELM GROVE, WI53122-2063
 Phone: 262-785-5557
 Fax: 262-785-5586
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

103TC0700X 62 Psychologist, Clinical
 

Marriage & Family Therapist

106H00000X
Indicates primary specialty

NPI Profile & details for RUSSELL W BRETHAUER · (Male)

NPI # 1023062528
Status Active
Credentials PSYD.
Entity Individual
Enumeration date 05/19/2006
Last updated 10/18/2007 - About 19 years ago
Sole proprietor 1 Yes
Identifiers
  • WI License # 185
  • WI License # 983
  • WI Medicaid 39027200
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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