Provider Demographics
NPI:1932402070
Name:THAIN, SHERRY LYNN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:LYNN
Last Name:THAIN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1594
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74502
Mailing Address - Country:US
Mailing Address - Phone:918-470-0532
Mailing Address - Fax:
Practice Address - Street 1:1500 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:HARTSHORNE
Practice Address - State:OK
Practice Address - Zip Code:74547-3842
Practice Address - Country:US
Practice Address - Phone:918-470-0532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3660235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist