Provider Demographics
NPI:1407097082
Name:LITTLE, ANGELA K (SLP-A)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:K
Last Name:LITTLE
Suffix:
Gender:F
Credentials:SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 N WICKHAM RD
Mailing Address - Street 2:12-309
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-7976
Mailing Address - Country:US
Mailing Address - Phone:321-724-4482
Mailing Address - Fax:
Practice Address - Street 1:2075 MEADOWLANE AVE
Practice Address - Street 2:
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-4951
Practice Address - Country:US
Practice Address - Phone:321-724-4482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI 16382355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant