MEDICARE: LIVINGSTON ENTERPRISES INC

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	235Z00000X	Speech-Language Pathologist	0300094	CO

General Provider Information

NPI Number	:	1245520105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVINGSTON ENTERPRISES INC

Provider Business Mailing Address
First Line	:	2917 MESA RD
Second Line	:	#A
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904-8121
Country	:	US
Telephone Number	:	719-442-6653
Fax Number	:	719-623-0600

Provider Business Practice Location Address
First Line	:	5040 CORPORATE PLAZA DR
Second Line	:	SUITE 8
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-3132
Country	:	US
Telephone Number	:	719-442-6653
Fax Number	:	719-623-0600

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. CHRISTINE LIVINGSTON
Credential	:	MA CCC-SLP
Telephone Number	:	719-442-6653

Provider Enumeration Date	:	04/12/2011
Last Update Date	:	04/12/2011

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Directions to “LIVINGSTON ENTERPRISES INC ” Practice Location

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