Organization
BUCK JACK, LLC
Active
Other names
Woven Care
Organization subpart
No
Provider details
NPI number
Authorized official
TANNER HALL (CREDENTIALING SPECIALIST)
(719) 597-0822
Entity
Organization
Contact information
Practice address
1321 S PRAIRIE AVE, PUEBLO, CO 81005-2307
(719) 597-0822
(719) 599-4606
Mailing address
2233 ACADEMY PL STE 200, COLORADO SPRINGS, CO 80909-1666
(719) 597-0822
(719) 599-4606
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
106S00000X
Behavior Technician
—
—
224Z00000X
Occupational Therapy Assistant
—
—
225100000X
Physical Therapist
—
—
225200000X
Physical Therapy Assistant
—
—
225X00000X
Occupational Therapist
—
—
2355S0801X
Speech-Language Assistant
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
12/20/2024
Last updated
12/20/2024
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