Provider Demographics
NPI:1396516423
Name:LITTERST, CINDY (CHW)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:LITTERST
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:STE GENEVIEVE
Mailing Address - State:MO
Mailing Address - Zip Code:63670-1828
Mailing Address - Country:US
Mailing Address - Phone:573-883-3524
Mailing Address - Fax:573-883-7991
Practice Address - Street 1:190 PLAZA DR
Practice Address - Street 2:
Practice Address - City:STE GENEVIEVE
Practice Address - State:MO
Practice Address - Zip Code:63670-1828
Practice Address - Country:US
Practice Address - Phone:573-883-3524
Practice Address - Fax:573-883-7991
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO15193172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker