Provider Demographics
NPI:1225400468
Name:LITTLEPAGE, PORSCHE GABRIELLE (BA)
Entity Type:Individual
Prefix:MS
First Name:PORSCHE
Middle Name:GABRIELLE
Last Name:LITTLEPAGE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1777 S 2300 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-3030
Mailing Address - Country:US
Mailing Address - Phone:484-326-9238
Mailing Address - Fax:
Practice Address - Street 1:1063 E 200 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2566
Practice Address - Country:US
Practice Address - Phone:484-326-9238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool