Provider Demographics
NPI:1609225440
Name:HARDY SWANN, JESSICA NICHOLE (PSYD)
Entity Type:Individual
Prefix:
First Name:JESSICA NICHOLE
Middle Name:
Last Name:HARDY SWANN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 GRAND AVE
Mailing Address - Street 2:SUITE 005
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-3642
Mailing Address - Country:US
Mailing Address - Phone:404-819-8900
Mailing Address - Fax:
Practice Address - Street 1:1001 GRAND AVE
Practice Address - Street 2:SUITE 005
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-3642
Practice Address - Country:US
Practice Address - Phone:404-819-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-10
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0005084103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical