| Pediatric Psychology Services Of Colorado | |
|
1001 Grand Ave Suite 005 Glenwood Springs CO 81601-3642 | |
| (404) 819-8900 | |
| (970) 549-2874 |
| Full Name | Pediatric Psychology Services Of Colorado |
|---|---|
| Speciality | Psychologist |
| Location | 1001 Grand Ave, Glenwood Springs, Colorado |
| Authorized Official Name and Position | Jessica Nichole Hardy Swann (OWNER) |
| Authorized Official Contact | 9709240484 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric Psychology Services Of Colorado 1001 Grand Ave Suite 005 Glenwood Springs CO 81601-3642 Ph: (404) 819-8900 | Pediatric Psychology Services Of Colorado 1001 Grand Ave Suite 005 Glenwood Springs CO 81601-3642 Ph: (404) 819-8900 |
| NPI Number | 1265066146 |
|---|---|
| Provider Enumeration Date | 02/28/2020 |
| Last Update Date | 08/05/2020 |
| Certification Date | 08/05/2020 |
| Medicare PECOS PAC ID | 0143650309 |
|---|---|
| Medicare Enrollment ID | O20200501000220 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265066146 | NPI | - | NPPES |
| 1609225440 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Jessica Nichole Hardy Swann |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1609225440 PECOS PAC ID: 8123452521 Enrollment ID: I20191217003138 |
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