Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 1995 | WI |
NPI | 1134173776 |
---|---|
Provider Name | Dr. Cheryl L Brosig Soto |
First Address | Milwaukee, WI 53226-3518 |
Second Address | Milwaukee, WI 53226-3518 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 15/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1134173776 | (05) | WI |