Provider Demographics
NPI:1962133389
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:PSYD
Authorized Official - Phone:970-665-4744
Mailing Address - Street 1:3225 I-70 BUSINESS LOOP UNIT 1A1
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:CO
Mailing Address - Zip Code:81520-7625
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3225 I-70 BUSINESS LOOP UNIT 1A1
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:CO
Practice Address - Zip Code:81520-7625
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:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty