Healthcare Provider Details

I. General information

NPI: 1053141689
Provider Name (Legal Business Name): CLAIRE AE KULIBERT MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CLAIRE AE LUEBKE MSW

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2702 INTERNATIONAL LN STE 102
MADISON WI
53704-3117
US

IV. Provider business mailing address

PO BOX 301
PORTAGE WI
53901-0301
US

V. Phone/Fax

Practice location:
  • Phone: 608-405-5712
  • Fax: 608-268-9780
Mailing address:
  • Phone: 608-742-5518
  • Fax: 608-268-9780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12937-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: