Healthcare Provider Details

I. General information

NPI: 1891911004
Provider Name (Legal Business Name): MS. JENNIFER JULIANA SWANBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 W INTERNATIONAL AIRPORT RD
ANCHORAGE AK
99518-1105
US

IV. Provider business mailing address

540 W INTERNATIONAL AIRPORT RD
ANCHORAGE AK
99518-1105
US

V. Phone/Fax

Practice location:
  • Phone: 907-561-5335
  • Fax: 907-564-7429
Mailing address:
  • Phone: 907-561-5335
  • Fax: 907-564-7429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberNCC 34245
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDC II 3257
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberMAC 34245
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0190131
License Number StateNM
# 5
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number402
License Number StateAK
# 6
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLCPC-318
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: