Provider Demographics
NPI:1447430079
Name:LITTLE, KATRYN
Entity Type:Individual
Prefix:
First Name:KATRYN
Middle Name:
Last Name:LITTLE
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 1:253 AIKEN AVE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01850-1256
Mailing Address - Country:US
Mailing Address - Phone:508-813-6261
Mailing Address - Fax:
Practice Address - Street 1:2175 NW SHEVLIN PARK RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-7101
Practice Address - Country:US
Practice Address - Phone:508-813-6261
Practice Address - Fax:541-278-8375
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-12
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
MA1194471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator