Provider Demographics
NPI:1356467310
Name:VOIGT, JESSICA TARYN (AUD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:TARYN
Last Name:VOIGT
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 LAKE OTIS PKWY
Mailing Address - Street 2:SUITE 302
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5215
Mailing Address - Country:US
Mailing Address - Phone:907-561-1326
Mailing Address - Fax:
Practice Address - Street 1:4200 LAKE OTIS PKWY
Practice Address - Street 2:SUITE 302
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5215
Practice Address - Country:US
Practice Address - Phone:907-561-1326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK64231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK64OtherSTATE LICENSE NUMBER
AKAU0064Medicaid