Jessica Blair Hetrick-Cano, PSYD, MSCP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

4106 Issued in CO

Practice address

2918 Beacon St
Colorado Springs, CO 80907-9208

Phone

(719) 964-8953

Fax

(719) 309-5864

NPI assigned

Jul 11, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 9

Addresses

Other names 1

• Dr. J. Blair Cano Professional name

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• J. Blair Cano, PSYD, MSCP

  • Clinical Psychologist
  • Monument, CO
  • NPI 1689282444
  NPD Authorized official
• Neurofeedback Colorado Springs, Inc.

  • Clinical Psychologist
  • Colorado Springs, CO
  • NPI 1972048098

  Clinical Neuropsychologist

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1341964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619740800000",
    "number": "1730444142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2918 BEACON ST",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809079208",
            "telephone_number": "719-964-8953",
            "fax_number": "719-309-5864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2918 BEACON ST",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809079208",
            "telephone_number": "719-964-8953",
            "fax_number": "719-309-5864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HETRICK-CANO",
        "first_name": "JESSICA",
        "middle_name": "BLAIR",
        "name_prefix": "Dr.",
        "credential": "PSYD, MSCP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-07-11",
        "last_updated": "2021-04-30",
        "certification_date": "2021-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "CO",
            "license": "4106",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "HI",
            "license": "1577",
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "CO",
            "license": "4106",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CO",
            "license": "4106",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "CO",
            "license": "4106",
            "primary": false
        },
        {
            "code": "103TH0004X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health",
            "state": "CO",
            "license": "4106",
            "primary": false
        },
        {
            "code": "103TM1800X",
            "taxonomy_group": "",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": "CO",
            "license": "4106",
            "primary": false
        },
        {
            "code": "103TR0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Rehabilitation",
            "state": "CO",
            "license": "4106",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CO",
            "license": "4106",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "J.",
            "last_name": "CANO",
            "middle_name": "BLAIR",
            "prefix": "DR.",
            "credential": "PSYD, MSCP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Ashley Hesselberg
• Diane Rebecca Hesselbrock, M.D.
• Janie Hessong, CSFA
• Danielle Loree Hester, AU.D.
• Sphy Hester
• Michael Ashton Hetterscheidt, DC
• Gnanin Joseph Hettiarachchy, M.D.
• Eric Lee Hetzel, DO
• Julia J Hetzel
• Stephanie Hetzel

• Psychologist in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Psychologist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.