1437491214 NPI number — MRS. LEKESHA RENE LIVINGSTON APSW

Table of content: MRS. LEKESHA RENE LIVINGSTON APSW (NPI 1437491214)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437491214 NPI number — MRS. LEKESHA RENE LIVINGSTON APSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIVINGSTON
Provider First Name:
LEKESHA
Provider Middle Name:
RENE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALLEN
Provider Other First Name:
LEKESHA
Provider Other Middle Name:
RENE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1437491214
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 W CAPITOL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53212-1123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-727-6320
Provider Business Mailing Address Fax Number:
414-727-6321

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 W CAPITOL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53212-1123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-727-6320
Provider Business Practice Location Address Fax Number:
414-727-6321
Provider Enumeration Date:
03/20/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  127620-121 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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