MEDICARE: ROBERTA D. LIVINGSTON LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	60401637	WA

General Provider Information

NPI Number	:	1174921795
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERTA D. LIVINGSTON LMT

Provider Business Mailing Address
First Line	:	18903 S FINLEY RD
Second Line	:
City	:	KENNEWICK
State	:	WA
Zip	:	99337-8729
Country	:	US
Telephone Number	:	509-947-2572
Fax Number	:

Provider Business Practice Location Address
First Line	:	815 S AUBURN ST
Second Line	:
City	:	KENNEWICK
State	:	WA
Zip	:	99336-5661
Country	:	US
Telephone Number	:	509-947-2572
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ROBERTA D LIVINGSTON
Credential	:	LMT
Telephone Number	:	509-947-2572

Provider Enumeration Date	:	12/13/2014
Last Update Date	:	02/04/2026

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