Provider Demographics
NPI:1700306271
Name:REILLY, CARRINGTON JAYDE
Entity type:Individual
Prefix:MRS
First Name:CARRINGTON
Middle Name:JAYDE
Last Name:REILLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 GREENBANK DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-9750
Mailing Address - Country:US
Mailing Address - Phone:803-317-9229
Mailing Address - Fax:
Practice Address - Street 1:181 TOWN CREEK RD
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-5841
Practice Address - Country:US
Practice Address - Phone:803-642-0700
Practice Address - Fax:803-642-0588
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-26
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6259235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist