Buck Jack, Llc Dba The Shandy Clinic is a
Behavior Analyst based in Pueblo, Colorado. Buck Jack, Llc Dba The Shandy Clinic is licensed to practice in * (Not Available) (license number ) and their current practice location is
1325 S Prairie Ave, Pueblo, Colorado. It can be reached at their office (for appointments etc.) via phone at
(719) 597-0822.
NPI number for Buck Jack, Llc Dba The Shandy Clinic is 1891443370 and their current mailing address is 2233 Academy Pl Ste 200, Colorado Springs, Colorado. Buck Jack, Llc Dba The Shandy Clinic
does not participate in medicare program and thus does not accept medicare assignments. The facility's NPI Number is 1891443370.
Healthcare Provider's Profile
| Full Name | Buck Jack, Llc Dba The Shandy Clinic |
|---|
| Type | Facility |
|---|
| Speciality | Behavior Analyst |
|---|
| Location | 1325 S Prairie Ave, Pueblo, Colorado |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1891443370
- Provider Enumeration Date: 03/14/2022
- Last Update Date: 02/28/2024
Medical Identifiers
Medical identifiers for Buck Jack, Llc Dba The Shandy Clinic such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1891443370 | NPI | - | NPPES |
| 9000203726 | Medicaid | CO | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 225100000X | Physical Therapist | (* (Not Available)) | Secondary |
| 225X00000X | Occupational Therapist | (* (Not Available)) | Secondary |
| 103T00000X | Psychologist | (* (Not Available)) | Secondary |
| 235Z00000X | Speech-language Pathologist | (* (Not Available)) | Secondary |
| 106S00000X | Behavior Technician | (* (Not Available)) | Secondary |
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Buck Jack, Llc Dba The Shandy Clinic is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Buck Jack, Llc Dba The Shandy Clinic
2233 Academy Pl Ste 200,
Colorado Springs, CO 80909-1666
Ph: (719) 597-0822 | Buck Jack, Llc Dba The Shandy Clinic
1325 S Prairie Ave,
Pueblo, CO 81005-2326
Ph: (719) 597-0822 |
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