MEDICARE: JESSICA LITTLE LCSW

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	1041C0700X	Clinical Social Worker	9808374-3501	UT

General Provider Information

NPI Number	:	1710336052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LITTLE LCSW

Provider Business Mailing Address
First Line	:	PO BOX 9146
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-0146
Country	:	US
Telephone Number	:	385-213-1062
Fax Number	:

Provider Business Practice Location Address
First Line	:	4505 S WASATCH BLVD STE 360D
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-4709
Country	:	US
Telephone Number	:	385-213-1062
Fax Number	:

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

Provider Enumeration Date	:	06/07/2016
Last Update Date	:	12/15/2025

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