Healthcare Provider Details

I. General information

NPI: 1306840251
Provider Name (Legal Business Name): SPEECHCENTER LLC, D/B/A SIDEKICK THERAPY PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 CHARLOIS BLVD
WINSTON SALEM NC
27103-1508
US

IV. Provider business mailing address

210 CHARLOIS BLVD
WINSTON SALEM NC
27103-1508
US

V. Phone/Fax

Practice location:
  • Phone: 336-725-0222
  • Fax: 336-725-0454
Mailing address:
  • Phone: 336-725-0222
  • Fax: 336-725-0454

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: MS. JANEA HODGES
Title or Position: CREDENTIALING LEAD
Credential:
Phone: 336-725-0222