Provider Demographics
NPI:1891911004
Name:SWANBERG, JENNIFER JULIANA
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:JULIANA
Last Name:SWANBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 W INTERNATIONAL AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-1105
Mailing Address - Country:US
Mailing Address - Phone:907-561-5335
Mailing Address - Fax:907-564-7429
Practice Address - Street 1:540 W INTERNATIONAL AIRPORT RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-1105
Practice Address - Country:US
Practice Address - Phone:907-561-5335
Practice Address - Fax:907-564-7429
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK402101YP2500X
NCC 34245101Y00000X
AKCDC II 3257101YA0400X
IDLCPC-318101YP2500X
MAC 34245101YA0400X
NM0190131101YM0800X
AKCM 1600651171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCM 1600651Medicaid
AKCMG 1632613Medicaid