BUCK JACK LLC (NPI# 1215548425) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215548425 |
| Entity Type | Organization |
| Organization Name | BUCK JACK LLC |
| Other Organization Name | THE SHANDY CLINIC |
| Practice Address |
6190 Barnes Rd Colorado Springs CO 80922-2600 |
| Mailing Address |
685 Citadel Dr E Ste 580 Colorado Springs CO 80909-5381 |
| Practice Telephone | 7192471511 |
| Practice Fax Number | 7195994606 |
| Mailing Telephone | 7137259181 |
| Mailing Fax Number | 7195994606 |
| Enumeration Date | 2020-08-11 |
| 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 |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CO | 9000181601 | 05 |
| 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 |
6190 BARNES RD |
| City | COLORADO SPRINGS |
| State | CO |
| Zip Code | 80922-2600 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861494155 | Edward T Kimble | Specialist | 6190 Barnes Rd, Colorado Springs, CO 80922-2600 | 2005-06-01 |
| 1053919365 | Buck Jack LLC | Behavioral Analyst | 6190 Barnes Rd, Colorado Springs, CO 80922-2600 | 2020-10-09 |
| 1619574282 | Amy Shandy, Speech-language Pathologist, LLC | Behavioral Analyst | 6190 Barnes Rd, Colorado Springs, CO 80922-2600 | 2020-10-06 |
| 1518572841 | Amy Shandy, Speech-language Pathologist, LLC | Psychologist | 6190 Barnes Rd, Colorado Springs, CO 80922-2600 | 2020-09-14 |
| 1427663756 | Amy Shandy, Speech-language Pathologist, LLC | Behavior Technician | 6190 Barnes Rd, Colorado Springs, CO 80922-2600 | 2020-09-14 |
| 1417562323 | Michaela Harris | Behavioral Analyst | 6190 Barnes Rd, Colorado Springs, CO 80922-2600 | 2020-09-09 |
| 1619587409 | Buck Jack LLC | Behavioral Analyst | 6190 Barnes Rd, Colorado Springs, CO 80922-2600 | 2020-08-06 |
| 1669080719 | Esther L Bednar | Behavior Technician | 6190 Barnes Rd, Colorado Springs, CO 80922-2600 | 2020-07-15 |
| 1679191670 | Elizabeth Dandino | Behavior Technician | 6190 Barnes Rd, Colorado Springs, CO 80922-2600 | 2020-07-07 |
| 1568084846 | Mckenzie Kist | Speech-Language Pathologist | 6190 Barnes Rd, Colorado Springs, CO 80922-2600 | 2020-05-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427662709 | Emergency Medical Specialists, PC | Emergency Medicine | Powers Fsed - Md, 2770 N. Powers Blvd, Colorado Springs, CO 80922 | 2020-09-03 |
| 1578177895 | Emergency Medical Specialists, PC | Emergency Medicine | Powers Fsed - App, 2770 N. Powers Blvd, Colorado Springs, CO 80922 | 2020-09-03 |
| 1528566965 | Caitlin Corbeit Kroetsch | Massage Therapist | 5349 Ferraro Drive, Colorado Springs, CO 80922 | 2018-01-31 |
| 1154861169 | Miriam Freire | Dental Hygienist | 3759 Swainson Dr., Colorado Springs, CO 80922 | 2017-02-24 |
| 1528507712 | Brandon Hutchinson | Social Worker | 6972 Hillock Fr, Colorado Springs, CO 80922 | 2017-02-21 |
| 1841648052 | Delene Suzuki Babauta | Dental Assistant | 7279 Withers Pl, Colorado Springs, CO 80922 | 2016-05-27 |
| 1225442601 | Betsy Titus | Physical Therapy Assistant | 6355 Silverado Trl, Colorado Springs, CO 80922 | 2014-06-13 |
| 1255754214 | Lynor Dicang Hardy | Military Health Care Provider | Cheyenne Mountain Air Station, Colorado Springs, CO 80922 | 2014-01-28 |
| 1861774184 | North Powers Modern Dentistry, LLP | Dentist | 5430 Tutt Boulevard, Colorado Springs, CO 80922 | 2011-09-13 |
| 1255589297 | Kendra D Robison | Internal Medicine | 6340 E Barnes Road, Colorado Springs Health Partners Internal Medicine, Colorado Springs, CO 80922 | 2008-09-03 |
| Find all providers in zip 80922 | ||||
| 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 | 80922 |
Please comment or provide details below to improve the information on BUCK JACK LLC.
| 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.