Provider Demographics
NPI:1194955237
Name:LITTELL, KRISTY HOGAN (SLP-CCC)
Entity type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:HOGAN
Last Name:LITTELL
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17500 COUNTY ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:NY
Mailing Address - Zip Code:13634-2028
Mailing Address - Country:US
Mailing Address - Phone:315-639-4198
Mailing Address - Fax:
Practice Address - Street 1:17500 COUNTY ROUTE 59
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:NY
Practice Address - Zip Code:13634-2028
Practice Address - Country:US
Practice Address - Phone:315-639-4198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012990-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist