Provider Demographics
NPI:1548607963
Name:HULBERT, KATHERINE MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARIE
Last Name:HULBERT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:MARIE
Other - Last Name:MENGLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:6502 GRAND TETON PLAZA SUITE 206
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1047
Mailing Address - Country:US
Mailing Address - Phone:608-827-7220
Mailing Address - Fax:608-827-7223
Practice Address - Street 1:809 PARK AVE
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-2205
Practice Address - Country:US
Practice Address - Phone:920-887-3171
Practice Address - Fax:920-887-8622
Is Sole Proprietor?:No
Enumeration Date:2013-05-24
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7938-1231041C0700X
IL149.0124941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical