Provider Demographics
NPI:1083025910
Name:LITTLE, JEANNELLE KEISHA (MSED)
Entity Type:Individual
Prefix:
First Name:JEANNELLE
Middle Name:KEISHA
Last Name:LITTLE
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 E 29TH ST BSMT APT
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-7169
Mailing Address - Country:US
Mailing Address - Phone:347-528-5211
Mailing Address - Fax:
Practice Address - Street 1:308 E 29TH ST BSMT APT
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-7169
Practice Address - Country:US
Practice Address - Phone:347-528-5211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY829886141171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY829887141OtherEARLY CHILDHOOD EDUCATION (BIRTH- GRADE 2) INITIAL CERTIFICATION
NY829886141OtherSTUDENT WITH DISABILITIES (BIRTH- GRADE 2) INITIAL CERTIFICATION