Provider Demographics
NPI:1104031988
Name:LITTLE, JODI L (AUD, CCC-A)
Entity type:Individual
Prefix:DR
First Name:JODI
Middle Name:L
Last Name:LITTLE
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11830 HIGH DESERT RD
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-3043
Mailing Address - Country:US
Mailing Address - Phone:303-704-8540
Mailing Address - Fax:
Practice Address - Street 1:11830 HIGH DESERT RD
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-3043
Practice Address - Country:US
Practice Address - Phone:303-704-8540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO355231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO25985761Medicaid