Healthcare Provider Details

I. General information

NPI: 1922217520
Provider Name (Legal Business Name): KENNETH WAYNE LITTLEFIELD PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E APACHE ST
WICKENBURG AZ
85390-2442
US

IV. Provider business mailing address

16848 W BRIDLINGTON AVE
SURPRISE AZ
85374-6865
US

V. Phone/Fax

Practice location:
  • Phone: 928-684-4359
  • Fax:
Mailing address:
  • Phone: 623-546-7164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3529
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: