Provider Demographics
NPI:1104868249
Name:LITTLE, JENNIFER L (AUD, CCC-A)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:LITTLE
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:LOPINTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:PO BOX 17334
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-1334
Mailing Address - Country:US
Mailing Address - Phone:703-443-6717
Mailing Address - Fax:703-443-8643
Practice Address - Street 1:6355 WALKER LN
Practice Address - Street 2:308
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-3245
Practice Address - Country:US
Practice Address - Phone:703-313-7700
Practice Address - Fax:703-313-0178
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001512231H00000X
VA2101001991237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist