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Organization
BUCK JACK, LLC
Active
Organization
BUCK JACK, LLC
Active
Other names
THE SHANDY CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
TANNER DENN (CREDENTIALING MANAGER)
(719) 428-1840
Entity
Organization
Contact information
Practice address
685 CITADEL DR E STE 580, COLORADO SPRINGS, CO 80909-5381
(719) 597-0822
(719) 599-4606
Mailing address
685 CITADEL DR E STE 580, COLORADO SPRINGS, CO 80909-5381
(719) 597-0822
(719) 599-4606
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
103T00000X
Psychologist
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
09/02/2021
Last updated
09/02/2021
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