Lara Buck Antolik, SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2015033921 Issued in MO

Practice address

4455 Duncan Ave
Dept Physical Therapy
Saint Louis, MO 63110-1111

Phone

(314) 286-1940

Fax

(314) 286-1473

NPI assigned

Jan 27, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Washington University

  • Multi-Specialty Clinic/Center
  • Saint Louis, MO
  • NPI 1356382527
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1580083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636934400000",
    "number": "1366073629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4444 FOREST PARK AVE",
            "address_2": "CB 8502",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631082212",
            "telephone_number": "314-286-1940",
            "fax_number": "314-747-7044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4455 DUNCAN AVE",
            "address_2": "DEPT PHYSICAL THERAPY",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101111",
            "telephone_number": "314-286-1940",
            "fax_number": "314-286-1473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTOLIK",
        "first_name": "LARA",
        "middle_name": "BUCK",
        "name_prefix": "Ms.",
        "credential": "SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-27",
        "last_updated": "2021-11-15",
        "certification_date": "2020-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MO",
            "license": "2015033921",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "460090762",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "4455 Duncan Ave",
            "address_2": "Dept Physical Therapy",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631101111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Natalie Beth Antin, MSW, LMSW
• Jastin L Antisdel, MD
• Antoine Eye Care, LLC
• Michael Antoine, O.D.
• Nichole Antoine, BCBA, LBA
• Camille Antonacci, OT
• Dianna L Antonacci, P.T., M.B.A.
• Laurie Antonetti
• Karth Antony, MD
• Amal F Antoun, M.D.

• Speech-Language Pathologist in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Speech-Language Pathologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.