Healthcare Provider Details

I. General information

NPI: 1083157515
Provider Name (Legal Business Name): SHERI LITTLE MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2016
Last Update Date: 12/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST
JACKSON MS
39216-4500
US

IV. Provider business mailing address

955 LAKESIDE DR
VICKSBURG MS
39180-9343
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-4124
  • Fax: 601-984-4119
Mailing address:
  • Phone: 601-415-1135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberS3369
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: