MEDICARE: CHANITA RENEE LITTLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1619691201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANITA RENEE LITTLE

Provider Business Mailing Address
First Line	:	2745 CEDAR GROVE DR
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62221-7411
Country	:	US
Telephone Number	:	618-604-0488
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 EXECUTIVE DR STE 200
Second Line	:
City	:	FAIRVIEW HTS
State	:	IL
Zip	:	62208-1350
Country	:	US
Telephone Number	:	618-688-4727
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2022
Last Update Date	:	09/28/2022

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Directions to “ CHANITA RENEE LITTLE ” Practice Location

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