Provider Demographics
NPI:1639518988
Name:THURBER, KELLY LYNN
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:LYNN
Last Name:THURBER
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 1:6253 STATE ROUTE 31
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-8730
Mailing Address - Country:US
Mailing Address - Phone:315-452-1600
Mailing Address - Fax:315-363-4661
Practice Address - Street 1:6253 STATE ROUTE 31
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-8730
Practice Address - Country:US
Practice Address - Phone:315-452-1600
Practice Address - Fax:315-288-5434
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000036480237700000X
NY14000051134237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist