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

General Provider Information

NPI Number	:	1891550661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC PSYCHOLOGY SERVICES OF COLORADO

Provider Business Mailing Address
First Line	:	618 ROOD AVE
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-2742
Country	:	US
Telephone Number	:	970-665-4744
Fax Number	:	970-665-4724

Provider Business Practice Location Address
First Line	:	33 N CASCADE AVE
Second Line	:
City	:	MONTROSE
State	:	CO
Zip	:	81401-3920
Country	:	US
Telephone Number	:	970-665-4744
Fax Number	:	970-665-4724

Authorized Official
Title or Position	:	OWNER
Name	:	JESSICA NICHOLE HARDY SWANN
Credential	:
Telephone Number	:	970-665-4744

Provider Enumeration Date	:	02/20/2024
Last Update Date	:	06/03/2026

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