1730211681 NPI number — MRS. BROOKE LITTLE MCDCFSLP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730211681 NPI number — MRS. BROOKE LITTLE MCDCFSLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LITTLE
Provider First Name:
BROOKE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MCDCFSLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LITTLE
Provider Other First Name:
BROOKE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MCDCFSLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1730211681
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 PINTAIL COVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARRISBURG
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-243-6247
Provider Business Mailing Address Fax Number:
870-578-6131

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3423 HIGHLAND DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
JONESBORO
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-336-0021
Provider Business Practice Location Address Fax Number:
870-336-0022
Provider Enumeration Date:
03/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SP#P7912 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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