Healthcare Provider Details

I. General information

NPI: 1629907340
Provider Name (Legal Business Name): PATRICK LITTLEJOHN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9417 S HARBOUR POINTE DR
BLOOMINGTON IN
47401-8100
US

IV. Provider business mailing address

9417 S HARBOUR POINTE DR
BLOOMINGTON IN
47401-8100
US

V. Phone/Fax

Practice location:
  • Phone: 812-929-6878
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: