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General NPI Number Information
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NPI Number | 1750723953
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Entity Type | Individual
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Provider Name | WILLIAM ELMER BRYLOW BCBA
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Gender | Male
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Dates
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Enumeration Date | 07/29/2013
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 10930 W POTTER RD STE A
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City | WAUWATOSA
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State | WI
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Zip | 53226-3450
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Country | US
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Telephone | 262-200-0900
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Fax |
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Provider Business Mailing Address
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Address Line | 2222 S 114TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53227-1031
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Country | US
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Telephone | 414-449-4444
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1311140
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License Number State | WI
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