Provider Demographics
NPI:1326689399
Name:LITTLE, ELIZABETH MADELINE (CF-SLP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MADELINE
Last Name:LITTLE
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HAVILAND RD
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-6607
Mailing Address - Country:US
Mailing Address - Phone:845-264-7763
Mailing Address - Fax:
Practice Address - Street 1:173 WEST SHORE DR.
Practice Address - Street 2:
Practice Address - City:PINE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:12567
Practice Address - Country:US
Practice Address - Phone:518-398-5432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program