Provider Demographics
NPI:1184240053
Name:LITTLE, BRETTELYN KNELL
Entity type:Individual
Prefix:DR
First Name:BRETTELYN
Middle Name:KNELL
Last Name:LITTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRETTELYN
Other - Middle Name:PAIGE
Other - Last Name:KNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1515 W NC HIGHWAY 54 STE 100
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-5575
Mailing Address - Country:US
Mailing Address - Phone:919-489-0995
Mailing Address - Fax:
Practice Address - Street 1:1515 W NC HIGHWAY 54 STE 100
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-5575
Practice Address - Country:US
Practice Address - Phone:919-489-0995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14265231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist