Basic Information
Provider Information
NPI: 1942443882
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LITTLEJOHN
FirstName: EMMA
MiddleName: ORADELL
NamePrefix:  
NameSuffix:  
Credential: LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 105 WEST 100 NORTH
Address2: P.O. BOX 867
City: PRICE
State: UT
PostalCode: 84501
CountryCode: US
TelephoneNumber: 4356377200
FaxNumber: 4356372377
Practice Location
Address1: 575 E 100 S
Address2:  
City: PRICE
State: UT
PostalCode: 84501
CountryCode: US
TelephoneNumber: 4356372358
FaxNumber: 4356379141
Other Information
ProviderEnumerationDate: 04/08/2009
LastUpdateDate: 06/13/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X7158543-3501UTY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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