NPIMap

Organization Active NPI

Buck Jack LLC

  • Speech-Language Pathologist
  • Colorado Springs, CO
National Provider Identifier
1184237299
Registry record updated Feb 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Legal business name
BUCK JACK LLC
Practice address
917 E Moreno Ave Ste 150
Colorado Springs, CO 80903-4547
Phone
(719) 623-6650
NPI assigned
Aug 28, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2024

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

Authorized official

Name
Tanner Denn
Title
Credentialing Specialist
Phone
(719) 428-1840

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103K00000X
PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103T00000X
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X
Occupational TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225X00000X
Speech-Language PathologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 235Z00000X Primary

Addresses

Primary practice location

917 E Moreno Ave Ste 150
Colorado Springs, CO 80903-4547

Mailing address

2233 Academy PL Ste 200
Colorado Springs, CO 80909-1666

Other identifiers 1

IdentifierTypeStateIssuer
9000185804MedicaidCO

Other names 1

  • Woven Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Buck Jack LLC70 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

917 E Moreno Ave
Ste 150
Colorado Springs, CO 80903
Phone (719) 623-6650

NPI Registry JSON

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

{
    "created_epoch": "1598572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709078400000",
    "number": "1184237299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2233 ACADEMY PL STE 200",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809091666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "917 E MORENO AVE STE 150",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809034547",
            "telephone_number": "719-623-6650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BUCK JACK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-28",
        "last_updated": "2024-02-28",
        "certification_date": "2024-02-28",
        "status": "A",
        "authorized_official_last_name": "DENN",
        "authorized_official_first_name": "TANNER",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "719-428-1840"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000185804",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Woven Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Colorado Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2024; 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.