Provider Demographics
NPI:1407078132
Name:LIVINGSTON, TRACY M (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:M
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21605 W 49TH ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66226-9745
Mailing Address - Country:US
Mailing Address - Phone:913-441-5227
Mailing Address - Fax:
Practice Address - Street 1:21605 W 49TH ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66226-9745
Practice Address - Country:US
Practice Address - Phone:913-441-5227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1734235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist