Individual provider Active NPI

Jordan Cannon, MSP CCC-SLP

  • Speech-Language Pathologist
  • Charlotte, NC
National Provider Identifier
1134528359
Registry record updated Jul 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
11536 Issued in NC
Practice address
3241 New Renaissance Way
Charlotte, NC 28208-6633
Phone
(980) 343-0049
Fax
(980) 343-0053
NPI assigned
Aug 14, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 11536 NC Primary
Speech-Language Pathologist 235Z00000X 5997 SC

Addresses

Primary practice location

3241 New Renaissance Way
Charlotte, NC 28208-6633

Mailing address

6740 Evanton Loch Rd
Charlotte, NC 28278-8010
Phone (219) 608-4219

Other practice location 1

4421 Stuart Andrew Blvd
Charlotte, NC 28217-1589
Phone (980) 343-6960

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
11536NCMDOral and Maxillofacial Surgery (Dentist)
5997SCMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Speechcenter LLC, D/B/a Sidekick Therapy Partners Speech-Language Pathologist Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1407974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784505600000",
    "number": "1134528359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6740 EVANTON LOCH RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282788010",
            "telephone_number": "219-608-4219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3241 NEW RENAISSANCE WAY",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282086633",
            "telephone_number": "980-343-0049",
            "fax_number": "980-343-0053"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4421 Stuart Andrew Blvd",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282171589",
            "country_code": "US",
            "telephone_number": "980-343-6960",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CANNON",
        "first_name": "JORDAN",
        "credential": "MSP CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-14",
        "last_updated": "2026-07-20",
        "certification_date": "2026-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NC",
            "license": "11536",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "SC",
            "license": "5997",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.