NPIMap

Organization Active NPI

Buck Jack LLC

Doing business as The Shandy Clinic

  • Speech-Language Pathologist
  • Colorado Springs, CO
National Provider Identifier
1871106997
Registry record updated Oct 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Legal business name
BUCK JACK LLC
Doing business as
The Shandy Clinic
Practice address
830 Tenderfoot Hill Rd Ste 100
Colorado Springs, CO 80906-7372
Phone
(719) 623-4500
NPI assigned
Aug 28, 2020
Last updated
Oct 1, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2020

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

Authorized official

Name
William Colt
Title
President
Phone
(713) 410-6889

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X NU
Clinical Psychologist 103TC0700X NU
Physical Therapist 225100000X NU
Occupational Therapist 225X00000X NU
Speech-Language Pathologist 235Z00000X NU Primary
Behavior Analyst 103K00000X NU

Addresses

Primary practice location

830 Tenderfoot Hill Rd Ste 100
Colorado Springs, CO 80906-7372

Mailing address

685 Citadel Dr E Ste 580
Colorado Springs, CO 80909-5381
Phone (713) 725-9181

Other names 1

  • The Shandy Clinic 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

830 Tenderfoot Hill Rd
Ste 100
Colorado Springs, CO 80906
Phone (702) 329-7287

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": "1601510400000",
    "number": "1871106997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "685 CITADEL DR E STE 580",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809095381",
            "telephone_number": "713-725-9181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 TENDERFOOT HILL RD STE 100",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809067372",
            "telephone_number": "719-623-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BUCK JACK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-28",
        "last_updated": "2020-10-01",
        "certification_date": "2020-10-01",
        "status": "A",
        "authorized_official_last_name": "COLT",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "713-410-6889"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Shandy Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Shandy Clinic",
            "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 Oct 1, 2020; 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.