Provider Demographics
NPI:1801873005
Name:LIVINGSTON, CHRISTINE (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2917 MESA RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-8121
Mailing Address - Country:US
Mailing Address - Phone:719-442-6653
Mailing Address - Fax:719-623-0600
Practice Address - Street 1:4465 NORTHPARK DR
Practice Address - Street 2:SUITE 211
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-4225
Practice Address - Country:US
Practice Address - Phone:719-442-6653
Practice Address - Fax:719-623-0600
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0465179235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO47921781Medicaid
CO68-0580536OtherEMPLOYER IDENTIFICATION N
CO26-2337027OtherEIN