MEDICARE: WILLIAM ELMER BRYLOW BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225400000X	Rehabilitation Practitioner
2	103K00000X	Behavior Analyst	1311140	WI

General Provider Information

NPI Number	:	1750723953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM ELMER BRYLOW BCBA

Provider Business Mailing Address
First Line	:	2222 S 114TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53227-1031
Country	:	US
Telephone Number	:	414-449-4444
Fax Number	:

Provider Business Practice Location Address
First Line	:	10930 W POTTER RD STE A
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53226-3450
Country	:	US
Telephone Number	:	262-200-0900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2013
Last Update Date	:	11/18/2024

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