Provider Demographics
NPI:1760006134
Name:FUNKE, KATHRYN (LICENSED SCHOOL PYSC)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:
Last Name:FUNKE
Suffix:
Gender:F
Credentials:LICENSED SCHOOL PYSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3631 NW 23RD PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-2621
Mailing Address - Country:US
Mailing Address - Phone:352-377-7392
Mailing Address - Fax:
Practice Address - Street 1:912 NW 56TH TER STE A
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-6404
Practice Address - Country:US
Practice Address - Phone:352-377-7392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS324103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool