Active NPI
Kenneth B. Little, M.A.
- Psychologist
- Roseville, MN
National Provider Identifier
1104869528
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- LP0568
- Practice address
- 1935 County Road B2 W Ste 120
Roseville, MN 55113-2722 - Phone
- (651) 964-0235
- Fax
- (651) 340-5652
- NPI assigned
- Jun 14, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | LP0568 | MN | Primary |
Addresses
Primary practice location
1935 County Road B2 W Ste 120
Roseville, MN 55113-2722
Mailing address
5505 Interlachen Blvd
Edina, MN 55436-1322
Phone (952) 300-7074
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1032815 | Other | MN | PREFERREDONE |
| 229D0LI | Other | MN | BLUE SHIELD OF MINNESOTA |
| 143646 | Other | MN | UCARE MINNESOTA |
| HP50066 | Other | MN | HEALTHPARTNERS |
| 62-47135 | Other | MN | UNITED BEHAVIORAL HEALTH |
| 976847500 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP0568 | MN | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1566172800000",
"number": "1104869528",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5505 INTERLACHEN BLVD",
"city": "EDINA",
"state": "MN",
"postal_code": "554361322",
"telephone_number": "952-300-7074"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1935 COUNTY ROAD B2 W STE 120",
"city": "ROSEVILLE",
"state": "MN",
"postal_code": "551132722",
"telephone_number": "651-964-0235",
"fax_number": "651-340-5652"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LITTLE",
"first_name": "KENNETH",
"middle_name": "B.",
"credential": "M.A.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-14",
"last_updated": "2019-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MN",
"license": "LP0568",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERREDONE",
"identifier": "1032815",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD OF MINNESOTA",
"identifier": "229D0LI",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE MINNESOTA",
"identifier": "143646",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPARTNERS",
"identifier": "HP50066",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED BEHAVIORAL HEALTH",
"identifier": "62-47135",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "976847500",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Roseville, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.