Healthcare Provider Details

I. General information

NPI: 1487633848
Provider Name (Legal Business Name): REBECCA A WEBER MA CCC SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REBECCA A FLEENOR

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 07/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3007 S BELT HWY
ST JOSEPH MO
64503
US

IV. Provider business mailing address

3007 S BELT HWY
ST JOSEPH MO
64503
US

V. Phone/Fax

Practice location:
  • Phone: 816-387-9800
  • Fax: 816-387-9374
Mailing address:
  • Phone: 816-387-9800
  • Fax: 816-387-9374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number01576
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number00506
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number01044342
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: