Provider Demographics
NPI:1811089071
Name:LITTLE, PAMELA CARLSON (LISW)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:CARLSON
Last Name:LITTLE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 4TH ST NW
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-3113
Mailing Address - Country:US
Mailing Address - Phone:641-423-4724
Mailing Address - Fax:641-423-3955
Practice Address - Street 1:125 4TH ST NW
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-3113
Practice Address - Country:US
Practice Address - Phone:641-423-4724
Practice Address - Fax:641-423-3955
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA51975OtherWELLMARK