Provider Demographics
NPI:1679762025
Name:LIVINGOOD, LISA
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:LIVINGOOD
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 1:5330 LAYTHAM PIKE
Mailing Address - Street 2:
Mailing Address - City:MAYSLICK
Mailing Address - State:KY
Mailing Address - Zip Code:41055-8930
Mailing Address - Country:US
Mailing Address - Phone:606-763-6255
Mailing Address - Fax:800-584-1465
Practice Address - Street 1:5330 LAYTHAM PIKE
Practice Address - Street 2:
Practice Address - City:MAYSLICK
Practice Address - State:KY
Practice Address - Zip Code:41055-8930
Practice Address - Country:US
Practice Address - Phone:606-763-6255
Practice Address - Fax:800-584-1465
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY 06-089235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist