Provider Demographics
NPI:1063116218
Name:THOMAS, RAEGAN (MS)
Entity type:Individual
Prefix:
First Name:RAEGAN
Middle Name:
Last Name:THOMAS
Suffix:
Gender:
Credentials:MS
Other - Prefix:
Other - First Name:RAEGAN
Other - Middle Name:
Other - Last Name:RUTLEDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:210 PEAR VIEW LN
Mailing Address - Street 2:
Mailing Address - City:PURLEAR
Mailing Address - State:NC
Mailing Address - Zip Code:28665-9452
Mailing Address - Country:US
Mailing Address - Phone:336-989-8972
Mailing Address - Fax:
Practice Address - Street 1:6606 FM 1488 RD # 668
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-2544
Practice Address - Country:US
Practice Address - Phone:281-798-6775
Practice Address - Fax:281-619-7048
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist