Healthcare Provider Details

I. General information

NPI: 1144111410
Provider Name (Legal Business Name): CAITLIN BRIANNA BUCKLEY M.S, CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 07/14/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12380 DEPAUL DR
BRIDGETON MO
63044
US

IV. Provider business mailing address

76 N RIDGEWYND CT
LAKE SAINT LOUIS MO
63367-4329
US

V. Phone/Fax

Practice location:
  • Phone: 314-447-9710
  • Fax:
Mailing address:
  • Phone: 636-293-4598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2025023002
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: