Healthcare Provider Details

I. General information

NPI: 1538948559
Provider Name (Legal Business Name): ALISON M CUPIT SPEECH PATHOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4358 HIGHWAY 84 W
VIDALIA LA
71373-3353
US

IV. Provider business mailing address

2425 POOLE RD
VIDALIA LA
71373-5737
US

V. Phone/Fax

Practice location:
  • Phone: 318-336-4226
  • Fax:
Mailing address:
  • Phone: 160-180-7966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3703
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: