Buck Jack, LLC
Organization Active NPI Speech-Language Pathologist · Fountain, CO
NPI 1376425959 · NPPES record last updated Jul 23, 2025
Key facts
- NPI
- 1376425959
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- Legal business name
- BUCK JACK, LLC
- Practice address
- 901 N Santa Fe Ave
Fountain, CO 80817-1738 - Phone
- (719) 597-0822
- NPI assigned
- Jul 23, 2025
- Organization subpart
- No
Authorized official
- Name
- Tanner Hall
- Title
- Internal Operations Manager
- Phone
- (719) 597-0822
Corporate family (same tax ID) 24
National Provider Directory
- Tax ID family
- Buck Jack LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst |
103K00000X | |||
| Behavior Technician |
106S00000X | |||
| Occupational Therapy Assistant |
224Z00000X | |||
| Physical Therapist |
225100000X | |||
| Physical Therapy Assistant |
225200000X | |||
| Occupational Therapist |
225X00000X | |||
| Speech-Language Pathologist |
235Z00000X | Yes |
Addresses
Primary practice location
901 N Santa Fe Ave
Fountain, CO 80817-1738
Mailing address
2233 Academy PL Ste 200
Colorado Springs, CO 80909-1666
Other names
- Woven Care
Other providers in Fountain, CO
- Buck Jack LLC
- Buck Jack LLC
- Buck Jack LLC
- Buck Jack, LLC
- Buck Jack, LLC
- Buck Jack, LLC
- Buck Jack, LLC
- Claudya Nicole Buckner
- Jamie Alexander Budhan
- Sheila Bufkin
All providers in Fountain, CO · Speech-Language Pathologist in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 23, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.