Individual
KENNETH B. LITTLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A.
Contact information
Practice address
1935 COUNTY ROAD B2 W STE 120, ROSEVILLE, MN 55113-2722
(651) 964-0235
(651) 340-5652
Mailing address
5505 INTERLACHEN BLVD, EDINA, MN 55436-1322
(952) 300-7074
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP0568
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1032815
PREFERREDONE
MN
01
—
143646
UCARE MINNESOTA
MN
01
—
229D0LI
BLUE SHIELD OF MINNESOTA
MN
01
—
62-47135
UNITED BEHAVIORAL HEALTH
MN
05
—
976847500
—
MN
01
—
HP50066
HEALTHPARTNERS
MN
Enumeration date
06/14/2006
Last updated
08/19/2019
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