Doctor Name: | JACQUELINE N BUCK |
NPI Number: | 1033383062 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PH.D. |
License Number: | 071.003131 |
Business Practice Address: | 3200 Fishback Rd Carbondale, IL - 629016307 |
Business Phone Number: | 6184571111 |
Business Fax Number: | 6183511419 |
Mailing Address: | 3200 Fishback Rd, CARBONDALE |
State: | IL |
Postal Code: | 629016307 |
Phone Number: | 6184571111 |
Fax Number: | 6183511419 |
NPI Enumeration Date: | 04/22/2008 |
NPI Last Update Date: | 04/22/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 071.003131 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |