Healthcare Provider Details

I. General information

NPI: 1770416471
Provider Name (Legal Business Name): JANA WHICKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
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:
Mailing address:
  • Phone: 336-725-0222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number30005215
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: