MEDICARE: PEDIATRIC PSYCHOLOGY SERVICES OF COLORADO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265066146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC PSYCHOLOGY SERVICES OF COLORADO

Provider Business Mailing Address
First Line	:	PO BOX 477
Second Line	:
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81602-0477
Country	:	US
Telephone Number	:	404-819-8900
Fax Number	:	970-549-2874

Provider Business Practice Location Address
First Line	:	1029 COLORADO AVE
Second Line	:
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81601-3319
Country	:	US
Telephone Number	:	404-819-8900
Fax Number	:	970-549-2874

Authorized Official
Title or Position	:	OWNER
Name	:	JESSICA NICHOLE HARDY SWANN
Credential	:	PSY.D.
Telephone Number	:	970-924-0484

Provider Enumeration Date	:	02/28/2020
Last Update Date	:	07/14/2025

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