Provider Demographics
NPI:1235562000
Name:FUNK, JULIANN MARGARET (MS, CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:JULIANN
Middle Name:MARGARET
Last Name:FUNK
Suffix:
Gender:F
Credentials:MS, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 S LITCHFIELD DR
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60073-8103
Mailing Address - Country:US
Mailing Address - Phone:630-263-7336
Mailing Address - Fax:
Practice Address - Street 1:200 N FAIRWAY DR
Practice Address - Street 2:SUITE 208
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1861
Practice Address - Country:US
Practice Address - Phone:847-996-6666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
146.011416235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist