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General NPI Number Information
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NPI Number | 1851889901
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Entity Type | Individual
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Provider Name | ELLIOT L BROCH PH.D
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Gender | Male
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Dates
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Enumeration Date | 04/24/2018
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 1250 N 113TH ST STE 200
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City | WAUWATOSA
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State | WI
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Zip | 53226-3209
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Country | US
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Telephone | 262-432-6600
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Fax | 262-432-6604
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Provider Business Mailing Address
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Address Line | 3384 N 51ST BLVD
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City | MILWAUKEE
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State | WI
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Zip | 53216-3238
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Country | US
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Telephone |
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 906-58
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 5283-57
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License Number State | WI
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