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BUCK JACK LLC NPI 1255964078


NPI Information

NPI: 1255964078
Provider Name: BUCK JACK LLC

Doing Business As: WOVEN CARE

Classification: Speech-Language Pathologist - 235Z00000X
Entity Type: Organization
Address:
3625 CITADEL DR S
COLORADO SPRINGS, CO
ZIP 80909
Phone: (719) 597-0822
Get Directions

BUCK JACK LLC is a speech language pathologist in Colorado Springs, CO. The provider is the speech-language pathologist is the professional who engages in clinical services, prevention, advocacy, education, administration, and research in the areas of communication and swallowing across the life span from infancy through geriatrics. Speech-language pathologists address typical and atypical impairments and disorders related to communication and swallowing in the areas of speech sound production, resonance, voice, fluency, language (comprehension and expression), cognition, and feeding and swallowing. BUCK JACK LLC NPI is 1255964078. The provider is registered as an organization entity type and is a multiple single specialty group.
The provider Is Doing Business As Woven Care.

The provider's business location address is:

3625 CITADEL DR S
COLORADO SPRINGS, CO
ZIP 80909-320
Phone: (719) 597-0822
Fax: (719) 599-4606

The provider's authorized official is Tanner Sloan Denn .
The authorized official title is Credentialing Specialist and has the following contact phone number (719) 428-1840.

The enumeration date for this NPI number is 2/20/2020 and was last updated on 2/28/2024.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1225X00000XOccupational TherapistNo
2103K00000XBehavior AnalystNo
3103T00000XPsychologistNo
4106S00000XBehavior TechnicianNo
5225100000XPhysical TherapistNo
6235Z00000XSpeech-Language PathologistYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
19000181601MEDICAIDCOLORADO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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