Provider Demographics
NPI:1780633628
Name:LITTLEFIELD, ROGER JAY (MS)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:JAY
Last Name:LITTLEFIELD
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-4436
Mailing Address - Country:US
Mailing Address - Phone:712-262-2922
Mailing Address - Fax:712-262-3826
Practice Address - Street 1:201 E 11TH ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-4436
Practice Address - Country:US
Practice Address - Phone:712-262-2922
Practice Address - Fax:712-262-3826
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00443103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist