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General NPI Number Information
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NPI Number | 1245836956
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Entity Type | Organization
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Legal Business Name | LITTLE LIGHT THERAPY PLLC
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Dates
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Enumeration Date | 12/08/2020
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Last Update Date | 12/08/2020
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Provider Practice Location Address
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Address Line | 6285 SE TATER PEELER RD
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City | LEBANON
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State | TN
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Zip | 37090-0686
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Country | US
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Telephone | 615-549-7678
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Fax |
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Provider Business Mailing Address
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Address Line | 6285 SE TATER PEELER RD
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City | LEBANON
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State | TN
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Zip | 37090-0686
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Country | US
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Telephone | 615-584-8284
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | LAUREN CROTZER
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Credential | MS CCC-SLP
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Telephone | 615-584-8284
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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