Healthcare Provider Details

I. General information

NPI: 1669969135
Provider Name (Legal Business Name): LAURA ALICE LITTLE LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 N DETROIT ST STE 105
SUGARCREEK TOWNSHIP OH
45385-2963
US

IV. Provider business mailing address

100 CROWNE POINT PL
CINCINNATI OH
45241-5427
US

V. Phone/Fax

Practice location:
  • Phone: 376-104-6739
  • Fax: 937-736-2615
Mailing address:
  • Phone: 513-743-7628
  • Fax: 937-736-2615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1502009
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: