Provider Demographics
NPI:1518748953
Name:JESSICA FUNK, PSYD, PC
Entity Type:Organization
Organization Name:JESSICA FUNK, PSYD, PC
Other - Org Name:JESSICA FUNK, PSYD, PC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:FUNK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:224-603-2119
Mailing Address - Street 1:PO BOX 2085
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60051-9034
Mailing Address - Country:US
Mailing Address - Phone:224-603-2119
Mailing Address - Fax:
Practice Address - Street 1:6406 CHICKALOON DR
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-6555
Practice Address - Country:US
Practice Address - Phone:224-603-2119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-11
Last Update Date:2023-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty