Provider Demographics
NPI:1558563403
Name:FUNK, BRIAN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:FUNK
Suffix:
Gender:M
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18758 ROUND LAKE RD
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-1494
Mailing Address - Country:US
Mailing Address - Phone:317-774-3377
Mailing Address - Fax:317-774-7337
Practice Address - Street 1:18758 ROUND LAKE RD
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-1494
Practice Address - Country:US
Practice Address - Phone:317-774-3377
Practice Address - Fax:317-774-7337
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003274A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist