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NPI Code Detail

MEDICARE: LOGAN BUCZINSKI

MEDICARE: LOGAN BUCZINSKI
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianCO

General Provider Information

NPI Number : 1518823624
Entity Type Code : Individual
Provider Name (Legal Business Name) : LOGAN BUCZINSKI
Provider Business Mailing Address
First Line : 1330 QUAIL LAKE LOOP
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80906-4651
Country : US
Telephone Number : 719-540-1208
Fax Number :
Provider Business Practice Location Address
First Line : 1330 QUAIL LAKE LOOP
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80906-4651
Country : US
Telephone Number : 719-540-1208
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2026
Last Update Date : 01/02/2026

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Directions to “ LOGAN BUCZINSKI ” Practice Location

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