Healthcare Provider Details

I. General information

NPI: 1922380286
Provider Name (Legal Business Name): DEBORAH F LIVINGSTON AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 06/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 TENEYCK ST STE 200
JACKSON MI
49201-2461
US

IV. Provider business mailing address

PO BOX 67000 DEPARTMENT 272801
DETROIT MI
48267-2728
US

V. Phone/Fax

Practice location:
  • Phone: 517-787-1468
  • Fax: 517-787-0613
Mailing address:
  • Phone: 517-787-1468
  • Fax: 517-787-0613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number01238
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1601000611
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: