Healthcare Provider Details

I. General information

NPI: 1720392731
Provider Name (Legal Business Name): TERRI LYNCH-KENYON M.A.,CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2010
Last Update Date: 08/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 PENNSYLVANIA AVE 1C
WILMINGTON DE
19806-1392
US

IV. Provider business mailing address

2300 PENNSYLVANIA AVE 1C
WILMINGTON DE
19806-1392
US

V. Phone/Fax

Practice location:
  • Phone: 302-654-1011
  • Fax: 302-654-4313
Mailing address:
  • Phone: 302-654-1011
  • Fax: 302-654-4313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number02-0000113
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: