Healthcare Provider Details

I. General information

NPI: 1952723983
Provider Name (Legal Business Name): JESSICA CLARE OBUKHOV AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA CLARE WELLS AU.D.

II. Dates (important events)

Enumeration Date: 01/10/2014
Last Update Date: 08/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 PENN AVE 7TH FLOOR FACULTY PAVILION
PITTSBURGH PA
15224
US

IV. Provider business mailing address

4401 PENN AVE 7TH FLOOR FACULTY PAVILION
PITTSBURGH PA
15224-1334
US

V. Phone/Fax

Practice location:
  • Phone: 412-692-6050
  • Fax: 412-692-5302
Mailing address:
  • Phone: 412-692-6050
  • Fax: 412-692-5302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAT006440
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: