Provider Demographics
NPI:1366956286
Name:LITTLE, CASSONDRA JEAN EDEN (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:CASSONDRA
Middle Name:JEAN EDEN
Last Name:LITTLE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 286
Mailing Address - Street 2:
Mailing Address - City:MOUNT BETHEL
Mailing Address - State:PA
Mailing Address - Zip Code:18343-0286
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:906 ORCHARD RD
Practice Address - Street 2:
Practice Address - City:MOUNT BETHEL
Practice Address - State:PA
Practice Address - Zip Code:18343-5106
Practice Address - Country:US
Practice Address - Phone:570-977-6118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL013688235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty