Provider Demographics
NPI:1346527124
Name:SWERSKY, JESSICA L (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:SWERSKY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-1610
Mailing Address - Country:US
Mailing Address - Phone:719-275-1616
Mailing Address - Fax:719-275-4619
Practice Address - Street 1:490 N DIAMOND AVE
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-2521
Practice Address - Country:US
Practice Address - Phone:719-275-1616
Practice Address - Fax:719-275-4619
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12110433235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPENDINGMedicaid