MEDICARE: BUCK JACK UTAH, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	106S00000X	Behavior Technician
2	106E00000X	Assistant Behavior Analyst
3	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1952252231
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUCK JACK UTAH, LLC

Provider Business Mailing Address
First Line	:	2233 ACADEMY PL STE 200
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1666
Country	:	US
Telephone Number	:	719-597-0822
Fax Number	:	719-599-4606

Provider Business Practice Location Address
First Line	:	2005 E 2700 S STE 200
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-1766
Country	:	US
Telephone Number	:	719-597-0822
Fax Number	:	719-599-4606

Authorized Official
Title or Position	:	INTERNAL OPERATIONS MANAGER
Name	:	TANNER HALL
Credential	:
Telephone Number	:	719-597-0822

Provider Enumeration Date	:	02/04/2026
Last Update Date	:	02/04/2026

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Directions to “BUCK JACK UTAH, LLC ” Practice Location

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