Healthcare Provider Details

I. General information

NPI: 1265139901
Provider Name (Legal Business Name): STEPHANIE ANN LITTLE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7250 POE AVE STE 220
DAYTON OH
45414-2687
US

IV. Provider business mailing address

3575 QUEEN VICTORIA CT
BEAVERCREEK OH
45431-5707
US

V. Phone/Fax

Practice location:
  • Phone: 216-468-5000
  • Fax: 937-688-5000
Mailing address:
  • Phone: 937-554-6162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberP.7443
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberP.7443
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberP.7443
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: