Healthcare Provider Details

I. General information

NPI: 1649880873
Provider Name (Legal Business Name): VANESSA LITTLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 E 1ST ST STE 110
DIXON IL
61021-3169
US

IV. Provider business mailing address

325 ILLINOIS RT 2
DIXON IL
61021-9118
US

V. Phone/Fax

Practice location:
  • Phone: 815-284-1891
  • Fax:
Mailing address:
  • Phone: 815-284-6611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number166.001769
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: