Healthcare Provider Details

I. General information

NPI: 1255778460
Provider Name (Legal Business Name): JENNA STEWART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNA LEE RICHARDS

II. Dates (important events)

Enumeration Date: 05/29/2013
Last Update Date: 04/05/2026
Certification Date: 04/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 WESTCHESTER DR
HIGH POINT NC
27262-7008
US

IV. Provider business mailing address

1701 WESTCHESTER DR
HIGH POINT NC
27262-7008
US

V. Phone/Fax

Practice location:
  • Phone: 336-888-4604
  • Fax:
Mailing address:
  • Phone: 336-888-4604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: