Provider Demographics
NPI:1912415837
Name:BUCKNELL, ALANNA P (MSW, CACII)
Entity type:Individual
Prefix:
First Name:ALANNA
Middle Name:P
Last Name:BUCKNELL
Suffix:
Gender:F
Credentials:MSW, CACII
Other - Prefix:
Other - First Name:ALANNA
Other - Middle Name:P
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, CACII
Mailing Address - Street 1:421 S TEJON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-2139
Mailing Address - Country:US
Mailing Address - Phone:719-424-5330
Mailing Address - Fax:
Practice Address - Street 1:421 S TEJON ST STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-2139
Practice Address - Country:US
Practice Address - Phone:719-424-5330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-12
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACB.0006780103TA0400X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)