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General NPI Number Information
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NPI Number | 1346527124
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Entity Type | Individual
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Provider Name | JESSICA L SWERSKY CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 11/08/2011
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Last Update Date | 11/08/2011
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Provider Practice Location Address
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Address Line | 490 N DIAMOND AVE
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City | CANON CITY
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State | CO
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Zip | 81212-2521
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Country | US
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Telephone | 719-275-1616
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Fax | 719-275-4619
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Provider Business Mailing Address
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Address Line | 702 W 1ST ST
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City | SALIDA
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State | CO
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Zip | 81201-1610
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Country | US
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Telephone | 719-275-1616
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Fax | 719-275-4619
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 12110433
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License Number State | CO
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