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BUCK JACK LLC NPI 1982217097


NPI Information

NPI: 1982217097
Provider Name: BUCK JACK LLC

Doing Business As: THE SHANDY CLINIC

Classification: Speech-Language Pathologist - 235Z00000X
Entity Type: Organization
Address:
1321 S PRAIRIE AVE
PUEBLO, CO
ZIP 81005
Phone: (719) 569-4411
Get Directions

BUCK JACK LLC is a speech language pathologist in Pueblo, 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 1982217097. The provider is registered as an organization entity type and is a multiple single specialty group.
The provider Is Doing Business As The Shandy Clinic.

The provider's business location address is:

1321 S PRAIRIE AVE
PUEBLO, CO
ZIP 81005-307
Phone: (719) 569-4411

The provider's authorized official is William Colt .
The authorized official title is President and has the following contact phone number (713) 410-6889.

The enumeration date for this NPI number is 8/28/2020 and was last updated on 10/1/2020.


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
1103K00000XBehavior AnalystNo
2103T00000XPsychologistNo
3225100000XPhysical TherapistNo
4225X00000XOccupational TherapistNo
5235Z00000XSpeech-Language PathologistYes

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: 11/14/2023

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