Provider Demographics
NPI:1366650947
Name:LITTLE BEAR, DEBORAH K
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:K
Last Name:LITTLE BEAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14595
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95402-6595
Mailing Address - Country:US
Mailing Address - Phone:707-579-4159
Mailing Address - Fax:
Practice Address - Street 1:441 EARLE ST # B
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-5412
Practice Address - Country:US
Practice Address - Phone:707-579-4159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist