MEDICARE: DR. PATRICIA LEE BROMLEY PH.D.

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	103TC1900X	Counseling Psychologist	1885-057	WI
2	103T00000X	Psychologist	1885-057	WI

General Provider Information

NPI Number	:	1194790063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA LEE BROMLEY PH.D.

Provider Business Mailing Address
First Line	:	W5838 GREENING RD
Second Line	:
City	:	WHITEWATER
State	:	WI
Zip	:	53190-4026
Country	:	US
Telephone Number	:	262-495-8531
Fax Number	:	262-495-8532

Provider Business Practice Location Address
First Line	:	162 W MAIN ST STE G
Second Line	:
City	:	WHITEWATER
State	:	WI
Zip	:	53190-1995
Country	:	US
Telephone Number	:	262-495-8531
Fax Number	:	262-495-8532

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

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	12/30/2010

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