BUCK JACK LLC (NPI# 1184237299) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184237299 |
| Entity Type | Organization |
| Organization Name | BUCK JACK LLC |
| Other Organization Name | THE SHANDY CLINIC |
| Practice Address |
917 E Moreno Ave Ste 150 Colorado Springs CO 80903-4547 |
| Mailing Address |
685 Citadel Dr E Ste 580 Colorado Springs CO 80909-5381 |
| Practice Telephone | 7196236650 |
| Enumeration Date | 2020-08-28 |
| Last Update Date | 2020-10-01 |
| Authorized Official Name | WILLIAM COLT (PRESIDENT) |
| Authorized Official Telephone | 7134106889 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103K00000X | Behavioral Analyst | Behavioral Health & Social Service Providers | ||
| N | 103T00000X | Psychologist | Behavioral Health & Social Service Providers | ||
| N | 225100000X | Physical Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| N | 225X00000X | Occupational Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| Y | 235Z00000X | Speech-Language Pathologist | Speech, Language and Hearing Service Providers |
| Other Name | Type Code |
|---|---|
| The Shandy Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083212393 | Buck Jack LLC | Physical Therapist | Mountain View Core Knowledge School 890 Field Ave, Cannon City, CO 81212 | 2020-10-09 |
| 1912505116 | Buck Jack LLC | Behavioral Analyst | 1301 Fortino Blvd, Pueblo, CO 81008-2032 | 2020-10-12 |
| 1376141572 | Buck Jack LLC | Behavioral Analyst | 1321 S Prairie Ave, Pueblo, CO 81005-2307 | 2020-10-12 |
| 1568060754 | Buck Jack LLC | Behavioral Analyst | 830 Tenderfoot Hill Rd Ste 100, Colorado Springs, CO 80906-7372 | 2020-10-12 |
| 1730787920 | Buck Jack LLC | Behavioral Analyst | 917 E Moreno Ave Ste 150, Colorado Springs, CO 80903-4547 | 2020-10-12 |
| 1467050658 | Buck Jack LLC | Behavioral Analyst | 901 N Santa Fe Ave, Fountain, CO 80817-1738 | 2020-10-12 |
| 1104424423 | Buck Jack LLC | Behavioral Analyst | 3625 Citadel Dr S, Colorado Springs, CO 80909-5320 | 2020-10-09 |
| 1497353700 | Buck Jack LLC | Physical Therapist | 2233 Academy Pl Ste 201, Colorado Springs, CO 80909-1679 | 2020-10-09 |
| 1942808258 | Buck Jack LLC | Behavioral Analyst | 8540 Scarborough Dr Ste 300, Colorado Springs, CO 80920-7519 | 2020-10-09 |
| 1619575909 | Buck Jack LLC | Physical Therapist | 3901 E Yale Ave, Denver, CO 80210-6646 | 2020-10-09 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | Buck Jack LLC | 419 South Tejon Appt. 309, Colorado Springs, CO 80903 |
| Street Address |
917 E MORENO AVE STE 150 |
| City | COLORADO SPRINGS |
| State | CO |
| Zip Code | 80903-4547 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972019073 | Domenica Nicole Caleca | Physical Therapist | 917 E Moreno Ave Ste 150, Colorado Springs, CO 80903-4547 | 2017-12-27 |
| 1730787920 | Buck Jack LLC | Behavioral Analyst | 917 E Moreno Ave Ste 150, Colorado Springs, CO 80903-4547 | 2020-10-12 |
| 1265039838 | Amy Shandy, Speech-language Pathologist, LLC | Behavioral Analyst | 917 E Moreno Ave Ste 150, Colorado Springs, CO 80903-4547 | 2020-10-06 |
| 1003468307 | Haley Samantha Seidman | Speech-Language Pathologist | 917 E Moreno Ave Ste 150, Colorado Springs, CO 80903-4547 | 2019-07-16 |
| 1841758703 | Lauren Elizabeth Vilga | Speech-Language Pathologist | 917 E Moreno Ave Ste 150, Colorado Springs, CO 80903-4547 | 2019-03-08 |
| 1922571793 | Mckenzie Grace Golden | Physical Therapist | 917 E Moreno Ave Ste 150, Colorado Springs, CO 80903-4547 | 2019-01-04 |
| 1942702998 | Lauren Wooten | Physical Therapist | 917 E Moreno Ave Ste 150, Colorado Springs, CO 80903-4547 | 2018-03-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235752437 | Lisa Mae Bunch | Behavior Technician | 102 South Tajon St. Ste 1100, Colorado Springs, CO 80903 | 2020-05-21 |
| 1164045407 | Lajanae Davis | Behavior Technician | 102 S. Tajon Street Ste. 1100, Colorado Springs, CO 80903 | 2020-05-21 |
| 1144855321 | Quinn Macdonald | Specialist/Technologist | 1332 N Weber Street, Colorado Springs, CO 80903 | 2020-03-08 |
| 1043784994 | Neuro Peak Performance, LLC | Counselor | 801 N. Weber St Suite 101, Colorado Springs, CO 80903 | 2019-01-14 |
| 1356828297 | Heart of The Phoenix, LLC | Social Worker | 1422 N Hancock Ave Ste 1, Colorado Springs, CO 80903 | 2018-07-24 |
| 1699269290 | Jenevieve Marie Briand | Day Training/Habilitation Specialist | 427 E Colorado Ave Ste 225, Colorado Springs, CO 80903 | 2018-06-18 |
| 1669983292 | Robin Dina Shankman | Massage Therapist | 127 E. Las Animas, Colorado Springs, CO 80903 | 2017-10-23 |
| 1023559804 | Sean Michael Blumahrdt | Specialist/Technologist, Other | 13 South Tejon St, Ste 501, Colorado Springs, CO 80903 | 2017-03-14 |
| 1366980682 | Edge Medical Services | Clinic/Center | 152 West Colorado Ave, Colorado Springs, CO 80903 | 2017-02-07 |
| 1093267890 | Brittany Nicole Holmes | Behavioral Analyst | 938 S Sierra Madre, Colorado Springs, CO 80903 | 2016-10-27 |
| Find all providers in zip 80903 | ||||
| Taxonomy Code | 235Z00000X |
| Grouping | Speech, Language and Hearing Service Providers |
| Classification | Speech-Language Pathologist |
| 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. |
| Notes: "Scope of Practice in Speech-Language Pathology", American Speech-Language-Hearing Association, 2013. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093312639 | Mary Cogswell | Speech-Language Pathologist | 3024 Ellesmere Dr, Colorado Springs, CO 80922-1275 | 2020-10-06 |
| 1770195562 | Chloe Canaan | Speech-Language Pathologist | 11136 Cypress Tree Pt Apt 306, Colorado Springs, CO 80921-7709 | 2020-08-21 |
| 1598377582 | Leah Schrimpf | Speech-Language Pathologist | 1060 Harrison Rd, Colorado Springs, CO 80905-3586 | 2020-08-20 |
| 1912517269 | Sarah Wrede | Speech-Language Pathologist | 1525 Witches Willow Ln, Colorado Springs, CO 80906-6208 | 2020-08-02 |
| 1609485556 | Jane Allison Morgan | Speech-Language Pathologist | 18465 Woodhaven Dr, Colorado Springs, CO 80908-1303 | 2020-07-27 |
| 1194334169 | Jill Tullman & Associates, LLC | Speech-Language Pathologist | 7222 Commerce Center Dr Ste 255, Colorado Springs, CO 80919-2632 | 2020-07-27 |
| 1467070250 | Savannah Love Lee | Speech-Language Pathologist | 419 E Saint Vrain St, Colorado Springs, CO 80903-3020 | 2020-07-08 |
| 1205464880 | Madison Kurtz | Speech-Language Pathologist | 2233 Academy Pl Ste 200, Colorado Springs, CO 80909-1666 | 2020-03-30 |
| 1629604848 | Shyanne Heise | Speech-Language Pathologist | 1710 Jet Stream Dr Ste 105, Colorado Springs, CO 80921-3937 | 2020-03-19 |
| 1861025488 | Katie Monson | Speech-Language Pathologist | 4136 Coolwater Dr, Colorado Springs, CO 80916-5522 | 2020-02-21 |
| Find all providers in COLORADO SPRINGS | ||||
| City | COLORADO SPRINGS |
| Zip Code | 80903 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.