Provider Demographics
NPI:1043446248
Name:LIVINGSTON, ROXANNE K (MA)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:K
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 13TH ST. N.E.
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-4116
Mailing Address - Country:US
Mailing Address - Phone:503-362-1172
Mailing Address - Fax:
Practice Address - Street 1:185 13TH ST. N.E.
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4116
Practice Address - Country:US
Practice Address - Phone:503-362-1172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLPC0042101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional