1407601552 NPI number — TRACY SKERIK LITTLE

Table of content: TRACY SKERIK LITTLE (NPI 1407601552)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407601552 NPI number — TRACY SKERIK LITTLE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LITTLE
Provider First Name:
TRACY
Provider Middle Name:
SKERIK
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407601552
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6434 S NEWPORT CT # 80111
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTENNIAL
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80111-4661
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-915-2121
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CHERRY CREEK SCHOOL DISTRICT
Provider Second Line Business Practice Location Address:
4750 S. YOSEMITE ST.
Provider Business Practice Location Address City Name:
GREENWOOD VILLAGE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80111-1308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-915-2121
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/22/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SLP.0005159 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)