Provider Demographics
NPI:1194609792
Name:PORTER, SHANNAN CUPIT (M S CCC-SLP)
Entity type:Individual
Prefix:
First Name:SHANNAN
Middle Name:CUPIT
Last Name:PORTER
Suffix:
Gender:F
Credentials:M S CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9155 FIELD BROOK CT
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-9343
Mailing Address - Country:US
Mailing Address - Phone:251-454-1642
Mailing Address - Fax:
Practice Address - Street 1:2440 GORDON SMITH DR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36617-2319
Practice Address - Country:US
Practice Address - Phone:251-300-6180
Practice Address - Fax:251-307-1708
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1307235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist