Individual
JACQUELINE N BUCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
3200 FISHBACK RD, CARBONDALE, IL 62901-6307
(618) 457-1111
(618) 351-1419
Mailing address
3200 FISHBACK RD, CARBONDALE, IL 62901-6307
(618) 457-1111
(618) 351-1419
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071.003131
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
071.003131
STATE LICENSE
IL
Enumeration date
04/22/2008
Last updated
04/22/2008
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