Provider Demographics
NPI:1245542299
Name:LIVINGSTON, AMY (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-9781
Mailing Address - Country:US
Mailing Address - Phone:662-380-5170
Mailing Address - Fax:662-380-5271
Practice Address - Street 1:104 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-9781
Practice Address - Country:US
Practice Address - Phone:662-380-5170
Practice Address - Fax:662-380-5271
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-07
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS2355235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist