Healthcare Provider Details

I. General information

NPI: 1003026535
Provider Name (Legal Business Name): REBBECCA ANNICE PETERSEN M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBBECCA ANNICE HOYT M.S. CCC-SLP

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 06/28/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

998 PLATTE FALLS RD
PLATTE CITY MO
64079-7330
US

IV. Provider business mailing address

2509 WINDMILL DR
PLATTE CITY MO
64079-7523
US

V. Phone/Fax

Practice location:
  • Phone: 816-858-5420
  • Fax:
Mailing address:
  • Phone: 314-313-1601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2007003904
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: