Basic Information
| Provider Information | |||||||||
| NPI: | 1104941699 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LITTLE | ||||||||
| FirstName: | GABRIELLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3815 BRENDAN LN | ||||||||
| Address2: | APT2 | ||||||||
| City: | NORTH OLMSTED | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440702241 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 255 FRONT ST | ||||||||
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| City: | BEREA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440171943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402434000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SP-4259 | OH | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.