Provider Demographics
NPI:1215764642
Name:LITTLE, LATISHA S
Entity type:Individual
Prefix:MS
First Name:LATISHA
Middle Name:S
Last Name:LITTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LATISHA
Other - Middle Name:S
Other - Last Name:LEFLORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4175 N 62ND ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-1234
Mailing Address - Country:US
Mailing Address - Phone:414-807-5556
Mailing Address - Fax:
Practice Address - Street 1:4175 N 62ND ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-1234
Practice Address - Country:US
Practice Address - Phone:414-807-5556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI130503-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker