Provider Demographics
NPI:1841570256
Name:KULIBERT, NICOLE LYNN (CSAC, CSIT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LYNN
Last Name:KULIBERT
Suffix:
Gender:F
Credentials:CSAC, CSIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 SENTINEL DR
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189-7551
Mailing Address - Country:US
Mailing Address - Phone:262-594-9449
Mailing Address - Fax:262-549-6771
Practice Address - Street 1:325 SENTINEL DR
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53189-7551
Practice Address - Country:US
Practice Address - Phone:262-549-9449
Practice Address - Fax:262-549-6771
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15688-131101YA0400X
WI15754-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI15688-131OtherSTATE