Provider Demographics
NPI:1396543781
Name:FUNK, EMILY NICOLE PEYSAR (LGSW)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:NICOLE PEYSAR
Last Name:FUNK
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15798 110TH ST
Mailing Address - Street 2:
Mailing Address - City:FORESTON
Mailing Address - State:MN
Mailing Address - Zip Code:56330-9527
Mailing Address - Country:US
Mailing Address - Phone:218-316-1157
Mailing Address - Fax:
Practice Address - Street 1:105 UNION ST S STE 3
Practice Address - Street 2:
Practice Address - City:MORA
Practice Address - State:MN
Practice Address - Zip Code:55051-1592
Practice Address - Country:US
Practice Address - Phone:651-448-2322
Practice Address - Fax:833-466-1813
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN22190104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker