MEDICARE: MCKENNAH WHITACRE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	11922	MD

General Provider Information

NPI Number	:	1487446183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MCKENNAH WHITACRE

Provider Business Mailing Address
First Line	:	191 WOODS EDGE RD
Second Line	:
City	:	FORT ASHBY
State	:	WV
Zip	:	26719-6979
Country	:	US
Telephone Number	:	304-433-2112
Fax Number	:

Provider Business Practice Location Address
First Line	:	174 N MECHANIC ST
Second Line	:
City	:	CUMBERLAND
State	:	MD
Zip	:	21502-2316
Country	:	US
Telephone Number	:	240-284-3632
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2025
Last Update Date	:	05/20/2026

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Directions to “ MCKENNAH WHITACRE ” Practice Location

Language	Start Address	Practice Location

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