Healthcare Provider Details

I. General information

NPI: 1902724701
Provider Name (Legal Business Name): RAYNA TEAGUE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

602 E MAIN ST STE C
LEXINGTON SC
29072-3730
US

IV. Provider business mailing address

602 E MAIN ST STE C
LEXINGTON SC
29072-3730
US

V. Phone/Fax

Practice location:
  • Phone: 803-622-9865
  • Fax: 803-830-4729
Mailing address:
  • Phone: 803-622-9865
  • Fax: 803-830-4729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: