Provider Demographics
NPI:1033469127
Name:RABE, TESSA MARIE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:TESSA
Middle Name:MARIE
Last Name:RABE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MISS
Other - First Name:TESSA
Other - Middle Name:MARIE
Other - Last Name:DEATON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2401 GILLHAM RD
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPARTMENT
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-4619
Mailing Address - Country:US
Mailing Address - Phone:816-701-5200
Mailing Address - Fax:816-302-9939
Practice Address - Street 1:2401 GILLHAM RD
Practice Address - Street 2:PROVIDER ENROLLMENT DEPARTMENT
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-4619
Practice Address - Country:US
Practice Address - Phone:816-234-3000
Practice Address - Fax:816-302-9939
Is Sole Proprietor?:No
Enumeration Date:2012-09-15
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#P8581235Z00000X
MO2014007935235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist