Buck Jack, LLC
Buck Jack, LLC is a healthcare organization registered as Behavior Analyst in Pueblo, CO, holding Type 2 (organization) NPI 1700694908 since 2024. The authorized official on file is Tanner Hall, Credentialing Specialist.
✓ Active NPI ✓ Valid NPI checksum
| NPI | 1700694908 |
|---|---|
| Entity type | Organization (Type 2) |
| Legal business name | Buck Jack, LLC |
| Practice address | 1321 S PRAIRIE AVE, Pueblo, CO, 81005 |
| Phone | 7195970822 |
| Fax | 7195994606 |
| Enumeration date | 2024-12-20 |
| Last updated in NPPES | 2024-12-20 |
Authorized official
| Name | Tanner Hall |
|---|---|
| Title | Credentialing Specialist |
| Phone | 7195970822 |
Taxonomy & classification
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 106S00000X | Behavior Technician | Secondary | — | — |
| 224Z00000X | Occupational Therapy Assistant | Secondary | — | — |
| 225100000X | Physical Therapist | Secondary | — | — |
| 225200000X | Physical Therapy Assistant | Secondary | — | — |
| 225X00000X | Occupational Therapist | Secondary | — | — |
| 2355S0801X | Speech-Language Assistant | Secondary | — | — |
| 235Z00000X | Speech-Language Pathologist | Secondary | — | — |
| 103K00000X | Behavior Analyst | Primary | — | — |
Copy-ready billing details
Provider: Buck Jack, LLC NPI: 1700694908 Taxonomy: 103K00000X (Behavior Analyst) Address: 1321 S PRAIRIE AVE, Pueblo, CO, 81005
Providers at this address
| NPI | Name | Type | Specialty | Location |
|---|---|---|---|---|
| 1598284465 | Kendra Smallwood | Individual | Speech-Language Pathologist | Pueblo, CO |
| 1174034409 | Anne Martic | Individual | Physical Therapist | Pueblo, CO |
| 1235637018 | Josue Trancoso | Individual | Behavior Analyst | Pueblo, CO |
| 1114402658 | Melissa Volpe | Individual | Behavior Technician | Pueblo, CO |
| 1891268900 | Stephanie Johnson | Individual | Physical Therapist | Pueblo, CO |
| 1972163780 | Zia Sil | Individual | Speech-Language Pathologist | Pueblo, CO |
| 1831741685 | Tiffaney Salerno | Individual | Occupational Therapy Assistant | Pueblo, CO |
| 1003467820 | Amy Simpson | Individual | Occupational Therapist | Pueblo, CO |
Verify this record
Cross-check NPI 1700694908 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
Where is Buck Jack, LLC located?
How current is this record?
Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2024-12-20.