Provider Demographics
NPI:1558724005
Name:LITTLE, LAWRENCE CEDETTE III
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:CEDETTE
Last Name:LITTLE
Suffix:III
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:LAWRENCE
Other - Middle Name:CEDETTE
Other - Last Name:LITTLE
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:COTA/L
Mailing Address - Street 1:1201 N FAIRFIELD ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-3018
Mailing Address - Country:US
Mailing Address - Phone:360-637-8947
Mailing Address - Fax:
Practice Address - Street 1:800 N MEDCALF LN
Practice Address - Street 2:
Practice Address - City:MONTESANO
Practice Address - State:WA
Practice Address - Zip Code:98563-1318
Practice Address - Country:US
Practice Address - Phone:360-249-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-01
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC60264322172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker