Individual
DR. JESSICA BLAIR HETRICK-CANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD, MSCP
Contact information
Practice address
2918 BEACON ST, COLORADO SPRINGS, CO 80907-9208
(719) 964-8953
(719) 309-5864
Mailing address
2918 BEACON ST, COLORADO SPRINGS, CO 80907-9208
(719) 964-8953
(719) 309-5864
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
4106
CO
103T00000X
Psychologist
Primary
4106
CO
103TC0700X
Clinical Psychologist
1577
HI
103TC0700X
Clinical Psychologist
4106
CO
103TC1900X
Counseling Psychologist
4106
CO
103TC2200X
Clinical Child & Adolescent Psychologist
4106
CO
103TH0004X
Health Psychologist
4106
CO
103TM1800X
Intellectual & Developmental Disabilities Psychologist
4106
CO
103TR0400X
Rehabilitation Psychologist
4106
CO
Other
Enumeration date
07/11/2012
Last updated
04/30/2021
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