Individual
MS. LARA BUCK ANTOLIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
4455 DUNCAN AVE, DEPT PHYSICAL THERAPY, SAINT LOUIS, MO 63110-1111
(314) 286-1940
(314) 286-1473
Mailing address
4444 FOREST PARK AVE, CB 8502, SAINT LOUIS, MO 63108-2212
(314) 286-1940
(314) 747-7044
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2015033921
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
460090762
—
MO
Enumeration date
01/27/2020
Last updated
11/15/2021
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