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NPI Code Detail

MEDICARE: MARY K MCKENNA MS, CCC-SLP

MEDICARE: MARY K MCKENNA MS, CCC-SLP
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
1235Z00000XSpeech-Language Pathologist

General Provider Information

NPI Number : 1851248868
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY K MCKENNA MS, CCC-SLP
Provider Business Mailing Address
First Line : 191 COUNTY ROAD 4811
Second Line :
City : MERIDIAN
State : MS
Zip : 39301-7968
Country : US
Telephone Number : 662-801-5896
Fax Number :
Provider Business Practice Location Address
First Line : 1411 HIGHWAY 389
Second Line :
City : STARKVILLE
State : MS
Zip : 39759-8451
Country : US
Telephone Number : 662-769-4888
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2026
Last Update Date : 03/11/2026

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