Provider Demographics
NPI:1720469224
Name:LITTLE, KAREN NICOLE (MED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:NICOLE
Last Name:LITTLE
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 PINEWINDS DR APT 101
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-6701
Mailing Address - Country:US
Mailing Address - Phone:706-676-8384
Mailing Address - Fax:
Practice Address - Street 1:1535 E BOOKER DAIRY RD STE B
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-9450
Practice Address - Country:US
Practice Address - Phone:919-763-5703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2015-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11436235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist