Provider Demographics
NPI:1497303523
Name:COMER, JACQUELINE BRYONY (MA-CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:BRYONY
Last Name:COMER
Suffix:
Gender:F
Credentials:MA-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:PO BOX 6010
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28603-6010
Mailing Address - Country:US
Mailing Address - Phone:828-962-0604
Mailing Address - Fax:
Practice Address - Street 1:3031 TATE BLVD SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-1455
Practice Address - Country:US
Practice Address - Phone:828-322-3343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-02
Last Update Date:2019-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7840235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist