Provider Demographics
NPI:1992372874
Name:PEDIATRIC PSYCHOLOGY SERVICES OF COLORADO
Entity Type:Organization
Organization Name:PEDIATRIC PSYCHOLOGY SERVICES OF COLORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA NICHOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDY SWANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-924-0484
Mailing Address - Street 1:1001 GRAND AVE UNIT 5
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-3642
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:618 ROOD AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2742
Practice Address - Country:US
Practice Address - Phone:970-924-0484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-08
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty