Provider Demographics
NPI:1902930274
Name:COMSTOCK, CATHRYN L (AUD)
Entity Type:Individual
Prefix:DR
First Name:CATHRYN
Middle Name:L
Last Name:COMSTOCK
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 CANYON CREEK DR STE 140
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-3273
Mailing Address - Country:US
Mailing Address - Phone:254-774-7727
Mailing Address - Fax:254-771-1256
Practice Address - Street 1:1618 CANYON CREEK DR STE 140
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-3273
Practice Address - Country:US
Practice Address - Phone:254-774-7727
Practice Address - Fax:254-771-1256
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50228231HA2400X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145282301Medicaid
TX145282302Medicaid
TX580065Medicare ID - Type Unspecified
TX145282302Medicaid