Healthcare Provider Details

I. General information

NPI: 1437065604
Provider Name (Legal Business Name): MCKENNA CARPENTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 MAIN ST
TROY MO
63379-1130
US

IV. Provider business mailing address

15312 APPALACHIAN TRL
CHESTERFIELD MO
63017-1941
US

V. Phone/Fax

Practice location:
  • Phone: 636-528-4809
  • Fax:
Mailing address:
  • Phone: 314-637-7989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2026038804
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: