Provider Demographics
NPI:1972504009
Name:LITTLE, KATHRYN JOANN (MA, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:JOANN
Last Name:LITTLE
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:MRS
Other - First Name:KATHRYN
Other - Middle Name:JOANN
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA,CCC-A
Mailing Address - Street 1:215 SHUMAN BLVD
Mailing Address - Street 2:STE 401
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8123
Mailing Address - Country:US
Mailing Address - Phone:630-303-5380
Mailing Address - Fax:630-303-5385
Practice Address - Street 1:8202 CLEARVISTA PKWY
Practice Address - Street 2:STE 9C
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1457
Practice Address - Country:US
Practice Address - Phone:317-621-5713
Practice Address - Fax:317-913-1472
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23001962A237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200846360Medicaid
IN200846360Medicaid