Individual provider Active NPI

Samuel Wacker

  • Behavior Technician
  • Highlands Ranch, CO
National Provider Identifier
1174479406
Registry record updated Mar 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior TechnicianTaxonomy code 106S00000X
Practice address
630 Plaza Dr
Highlands Ranch, CO 80129-2379
Phone
(720) 470-0578
NPI assigned
Mar 9, 2026
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X CO Primary

Addresses

Primary practice location

630 Plaza Dr
Highlands Ranch, CO 80129-2379

Mailing address

2384 Cactus Bluff Ave
Highlands Ranch, CO 80129-6429
Phone (720) 470-0578

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1773014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773014400000",
    "number": "1174479406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2384 CACTUS BLUFF AVE",
            "city": "HIGHLANDS RANCH",
            "state": "CO",
            "postal_code": "801296429",
            "telephone_number": "720-470-0578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 PLAZA DR",
            "city": "HIGHLANDS RANCH",
            "state": "CO",
            "postal_code": "801292379",
            "telephone_number": "720-470-0578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WACKER",
        "first_name": "SAMUEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2026-03-09",
        "last_updated": "2026-03-09",
        "certification_date": "2026-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "CO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Highlands Ranch, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.