Provider Demographics
NPI:1134173776
Name:BROSIG SOTO, CHERYL L (PHD)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:L
Last Name:BROSIG SOTO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:CHERYL
Other - Middle Name:L
Other - Last Name:BROSIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:CHILDREN'S HEALTH SYS OFFICE BLDG
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3518
Mailing Address - Country:US
Mailing Address - Phone:414-266-2948
Mailing Address - Fax:414-266-3261
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:CHILDREN'S HEALTH SYS OFFICE BLDG
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3518
Practice Address - Country:US
Practice Address - Phone:414-266-2948
Practice Address - Fax:414-266-3261
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1995103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1134173776Medicaid
WI1134173776Medicaid