Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 4106 | CO |
N | 103TC0700X | Clinical Psychologist | 4106 | CO |
Y | 102L00000X | Psychologist | 4106 | CO |
Y | 103T00000X | Psychologist | 4106 | CO |
N | 103G00000X | Clinical Psychologist | 1577 | HI |
N | 103TC0700X | Clinical Psychologist | 1577 | HI |
N | 103G00000X | Clinical Psychologist | 4106 | CO |
N | 103TC0700X | Clinical Psychologist | 4106 | CO |
N | 103TC1900X | Counseling Psychologist | 4106 | CO |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 4106 | CO |
N | 103TH0004X | Health Psychologist | 4106 | CO |
N | 103TM1800X | Intellectual & Developmental Disabilities | 4106 | CO |
N | 103TR0400X | Rehabilitation Psychologist | 4106 | CO |
NPI | 1730444142 |
---|---|
Provider Name | Dr. Jessica Blair Hetrick-Cano |
First Address | Colorado Springs, CO 80907-9208 |
Second Address | Colorado Springs, CO 80907-9208 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2012 |
Last Update Date | 30/04/2021 |