Healthcare Provider Details

I. General information

NPI: 1003794199
Provider Name (Legal Business Name): KATELYN ANN LOWTHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 W FAYETTE ST FL 4
SYRACUSE NY
13204-2860
US

IV. Provider business mailing address

4860 THUNDER CLOUD DR
SYRACUSE NY
13215-1263
US

V. Phone/Fax

Practice location:
  • Phone: 315-435-4276
  • Fax:
Mailing address:
  • Phone: 315-466-3672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number036781
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: