Provider Demographics
NPI:1366944076
Name:LIVINGSTON SKINNER, JENNIFER DUVALL (LMT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DUVALL
Last Name:LIVINGSTON SKINNER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6835 RAVENCREST DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-1913
Mailing Address - Country:US
Mailing Address - Phone:719-231-2436
Mailing Address - Fax:
Practice Address - Street 1:4465 NORTHPARK DR STE 202
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-4238
Practice Address - Country:US
Practice Address - Phone:719-231-2436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT0019009225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist