Provider Demographics
NPI:1952723983
Name:OBUKHOV, JESSICA CLARE (AUD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:CLARE
Last Name:OBUKHOV
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:CLARE
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:4401 PENN AVE
Mailing Address - Street 2:7TH FLOOR FACULTY PAVILION
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-1334
Mailing Address - Country:US
Mailing Address - Phone:412-692-6050
Mailing Address - Fax:412-692-5302
Practice Address - Street 1:4401 PENN AVE
Practice Address - Street 2:7TH FLOOR FACULTY PAVILION
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224
Practice Address - Country:US
Practice Address - Phone:412-692-6050
Practice Address - Fax:412-692-5302
Is Sole Proprietor?:No
Enumeration Date:2014-01-10
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006440231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist