Provider Demographics
NPI:1174921795
Name:ROBERTA D. LIVINGSTON LMT
Entity type:Organization
Organization Name:ROBERTA D. LIVINGSTON LMT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:D
Authorized Official - Last Name:LIVINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:509-947-2572
Mailing Address - Street 1:18903 S FINLEY RD
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-8729
Mailing Address - Country:US
Mailing Address - Phone:509-947-2572
Mailing Address - Fax:
Practice Address - Street 1:5219 W CLEARWATER AVE STE 14
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-1980
Practice Address - Country:US
Practice Address - Phone:509-947-2572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-13
Last Update Date:2014-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60401637174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty