Provider Demographics
NPI:1548980790
Name:BUECHLER, JACK W
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:W
Last Name:BUECHLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 GOODPASTURE LOOP APT 133
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-1562
Mailing Address - Country:US
Mailing Address - Phone:763-258-9611
Mailing Address - Fax:
Practice Address - Street 1:219 42ND ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97478-5937
Practice Address - Country:US
Practice Address - Phone:541-224-6987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician