Provider Demographics
NPI:1528093192
Name:REBECK, PATRICIA S (PHD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:S
Last Name:REBECK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10590 BARKLEY ST
Mailing Address - Street 2:FL 2
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212
Mailing Address - Country:US
Mailing Address - Phone:913-381-1144
Mailing Address - Fax:
Practice Address - Street 1:10590 BARKLEY ST
Practice Address - Street 2:SUITE 200
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212
Practice Address - Country:US
Practice Address - Phone:913-381-1144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1012103TC0700X
MO2004005470103TC0700X
KSLP1012103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSR04378Medicare UPIN
MO000B016Medicare ID - Type UnspecifiedKANSAS CITY MEDICARE
KS119748Medicare Oscar/Certification