Individual
MRS. SHELONDA A PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED., CCC-SLP
Contact information
Practice address
3085 BENTWOOD DR, WAYCROSS, GA 31503-4117
(912) 288-0214
(912) 283-1570
Mailing address
3085 BENTWOOD DR, WAYCROSS, GA 31503-4117
(912) 288-0214
(912) 283-1570
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP005147
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10034561
—
GA
01
—
12039364
ASHA CERTIFICATION
—
01
—
1364319
GSHA MEMBERSHIP
GA
05
—
305511
—
GA
01
—
SLP005147
GA LICENSE
GA
Enumeration date
11/15/2006
Last updated
07/09/2007
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