Healthcare Provider Details

I. General information

NPI: 1609668748
Provider Name (Legal Business Name): PEDIATRIC PSYCHOLOGY SERVICES OF COLORADO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315E 1ST ST UNIT A
PARACHUTE CO
81635-5004
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:
  • 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