Lara Buck Antolik, SLP
Speech-Language Pathologist, in Saint Louis, MO. Individual provider (NPI-1).
NPI number1366073629
StatusActive
Last updated in NPPESNov 15, 2021
Details
- NPI
- 1366073629
- Entity type
- Individual (NPI-1)
- Name
- Ms. Lara Buck Antolik
- Credential
- SLP
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jan 27, 2020
- Certification date
- Jan 27, 2020
- Last updated
- Nov 15, 2021
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 235Z00000X | Speech-Language Pathologist, | 2015033921 | MO | Yes |
Practice location
4455 Duncan AveDept Physical Therapy
Saint Louis, MO 63110-1111
Phone 314-286-1940 · Fax 314-286-1473
Mailing address
4444 Forest Park AveCb 8502
Saint Louis, MO 63108-2212
Phone 314-286-1940 · Fax 314-747-7044
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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