Healthcare Provider Details

I. General information

NPI: 1891550661
Provider Name (Legal Business Name): PEDIATRIC PSYCHOLOGY SERVICES OF COLORADO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2024
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 N CASCADE AVE
MONTROSE CO
81401-3920
US

IV. Provider business mailing address

1029 COLORADO AVE
GLENWOOD SPRINGS CO
81601-3319
US

V. Phone/Fax

Practice location:
  • Phone: 970-665-4744
  • Fax:
Mailing address:
  • Phone: 970-665-4744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: JESSICA NICHOLE HARDY SWANN
Title or Position: OWNER
Credential:
Phone: 970-665-4744