Provider Demographics
NPI:1518731884
Name:LIVINGSTON, ALEXANDRA FAITH
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:FAITH
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 S OGDEN ST
Mailing Address - Street 2:
Mailing Address - City:STURGEON
Mailing Address - State:MO
Mailing Address - Zip Code:65284-9369
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:210 W PATTON ST
Practice Address - Street 2:
Practice Address - City:STURGEON
Practice Address - State:MO
Practice Address - Zip Code:65284-9564
Practice Address - Country:US
Practice Address - Phone:573-230-7287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20220194792355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant