Buck Jack LLC
Buck Jack LLC is a healthcare organization registered as Speech-Language Pathologist in Pueblo, CO, holding Type 2 (organization) NPI 1619580735 since 2020. The authorized official on file is Tanner Denn, Credentialing Specialist.
✓ Active NPI ✓ Valid NPI checksum
| NPI | 1619580735 |
|---|---|
| Entity type | Organization (Type 2) |
| Legal business name | Buck Jack LLC |
| Other name | <Unavail> |
| Practice address | 1301 FORTINO BLVD, Pueblo, CO, 81008 |
| Phone | 7196967799 |
| Enumeration date | 2020-08-28 |
| Last updated in NPPES | 2024-02-28 |
Authorized official
| Name | Tanner Denn |
|---|---|
| Title | Credentialing Specialist |
| Phone | 7194281840 |
Taxonomy & classification
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 103T00000X | Psychologist | Secondary | — | — |
| 225100000X | Physical Therapist | Secondary | — | — |
| 103K00000X | Behavior Analyst | Secondary | — | — |
| 225X00000X | Occupational Therapist | Secondary | — | — |
| 235Z00000X | Speech-Language Pathologist | Primary | — | — |
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9000188140 | Medicaid | CO | — |
Copy-ready billing details
Provider: Buck Jack LLC NPI: 1619580735 Taxonomy: 235Z00000X (Speech-Language Pathologist) Address: 1301 FORTINO BLVD, Pueblo, CO, 81008
Providers at this address
| NPI | Name | Type | Specialty | Location |
|---|---|---|---|---|
| 1629444096 | Shelby Bryant | Individual | Occupational Therapist | Pueblo, CO |
| 1730606948 | Jessica Royal-Ramirez | Individual | Pediatric Occupational Therapist | Pueblo, CO |
| 1679044622 | Michael Greenwood | Individual | Occupational Therapist | Pueblo, CO |
| 1396305611 | Mackenzie Holcomb | Individual | Pediatric Occupational Therapist | Pueblo, CO |
| 1801401153 | Amy Shandy, Speech-Language Pathologist, LLC | Organization | Speech-Language Pathologist | Pueblo, CO |
| 1245847243 | Katelynn Paulsen | Individual | Physical Therapist | Pueblo, CO |
| 1801493473 | Amy Shandy, Speech-Language Pathologist, LLC | Organization | Occupational Therapist | Pueblo, CO |
| 1912505116 | Buck Jack LLC | Organization | Occupational Therapist | Pueblo, CO |
Verify this record
Cross-check NPI 1619580735 against the authoritative CMS record: view Buck Jack LLC on the official NPPES registry .
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes — even if the provider moves or changes specialty. Read the full guide or validate an NPI number.
Frequently asked questions
Who is the authorized official for Buck Jack LLC?
What is the NPI number for Buck Jack LLC?
Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2024-02-28.