Provider Demographics
NPI:1912505082
Name:WEIDENAAR, REBEKAH SUE (PLPC)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:SUE
Last Name:WEIDENAAR
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 COUNTY ROAD 2455
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65259-2900
Mailing Address - Country:US
Mailing Address - Phone:660-414-7303
Mailing Address - Fax:
Practice Address - Street 1:503 W REED ST
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-1509
Practice Address - Country:US
Practice Address - Phone:573-575-8191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020033347101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional