Provider Demographics
NPI:1790486371
Name:SCHULZ BERGMAN, CLAIRE CHRISTINE (LCSW)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:CHRISTINE
Last Name:SCHULZ BERGMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 MEADOW SWEET DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-4516
Mailing Address - Country:US
Mailing Address - Phone:608-445-7794
Mailing Address - Fax:
Practice Address - Street 1:1229 MEADOW SWEET DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-4516
Practice Address - Country:US
Practice Address - Phone:608-445-7794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6886-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical