Buck Jack LLC
Speech-Language Pathologist, in Colorado Springs, CO. Organization (NPI-2).
NPI number1164025359
StatusActive
Last updated in NPPESNov 19, 2020
Details
- NPI
- 1164025359
- Entity type
- Organization (NPI-2)
- Legal business name
- Buck Jack LLC
- Organization subpart
- No
- Enumeration date
- Nov 19, 2020
- Certification date
- Nov 18, 2020
- Last updated
- Nov 19, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 235Z00000X | Speech-Language Pathologist, | – | – | Yes |
| 103K00000X | Behavior Analyst | – | – | |
| 103T00000X | Psychologist | – | – | |
| 106S00000X | Behavior Technician | – | – | |
| 225100000X | Physical Therapist | – | – | |
| 225X00000X | Occupational Therapist | – | – |
Other names
- The Shandy Clinic (Doing Business As)
Practice location
685 Citadel Dr E Ste 580Colorado Springs, CO 80909-5381
Phone 713-410-6889
Mailing address
685 Citadel Dr E Ste 580Colorado Springs, CO 80909-5381
Phone 713-410-6889
Authorized official
William Colt
President
7134106889
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