Provider Demographics
NPI:1487633848
Name:WEBER, REBECCA A (MA CCC SLP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:WEBER
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:A
Other - Last Name:FLEENOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3007 S BELT HWY
Mailing Address - Street 2:
Mailing Address - City:ST JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64503
Mailing Address - Country:US
Mailing Address - Phone:816-387-9800
Mailing Address - Fax:816-387-9374
Practice Address - Street 1:3007 S BELT HWY
Practice Address - Street 2:
Practice Address - City:ST JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64503
Practice Address - Country:US
Practice Address - Phone:816-387-9800
Practice Address - Fax:816-387-9374
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01576235Z00000X
KS00506235Z00000X
MO01044342235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
19620017SPEC089OtherBLUE CROSS BLUE SHIELD
MO468877006Medicaid
10001348400OtherCOMMUNITY HEALTH PLAN