Ellen Liversidge, M.S., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

5271 Issued in NM

Practice address

Hwy 64, Old High School Rd.
Shiprock, NM 87420

Phone

(505) 368-4984

NPI assigned

Mar 21, 2017

Last updated

Mar 21, 2017By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Central Consolidated School District

  • Public Health or Welfare Agency
  • Shiprock, NM
  • NPI 1023795192
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1490054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490054400000",
    "number": "1023549284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4923 DEL MONTE AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921073208",
            "telephone_number": "301-775-3649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "HWY 64, OLD HIGH SCHOOL RD.",
            "city": "SHIPROCK",
            "state": "NM",
            "postal_code": "87420",
            "telephone_number": "505-368-4984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIVERSIDGE",
        "first_name": "ELLEN",
        "credential": "M.S., CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-03-21",
        "last_updated": "2017-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NM",
            "license": "5271",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joy Mabe Lewis, WHNP-BC
• Carla F Lich, CDE CNP
• John T. Liesse, RN
• Katie WP Lippas, DDS
• Tanya Lister, CNM
• Carole Ann Livingston, PSY.D.
• Eric H Locher, MD
• Amber Lee Logan, DPT
• Aaron Francis Long, PHARMD
• Edith A. Love, RN

• Speech-Language Pathologist in Shiprock, NM
• Providers in Shiprock, NM by specialty
• Speech-Language Pathologist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.