Healthcare Provider Details

I. General information

NPI: 1003730367
Provider Name (Legal Business Name): JORDYN LEA REULECKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5526 N ACADEMY BLVD
COLORADO SPRINGS CO
80918-3681
US

IV. Provider business mailing address

2980 CORTINA DR
COLORADO SPRINGS CO
80918-1804
US

V. Phone/Fax

Practice location:
  • Phone: 719-301-5100
  • Fax: 719-301-5100
Mailing address:
  • Phone: 719-301-5100
  • Fax: 719-301-5100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number2754769
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: