Provider Demographics
NPI:1780802579
Name:FUNNELL, AMY L (MS CCC-A)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:FUNNELL
Suffix:
Gender:F
Credentials:MS CCC-A
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:SALAZAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4201 WINFIELD RD FL 3
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-4025
Mailing Address - Country:US
Mailing Address - Phone:331-221-6377
Mailing Address - Fax:
Practice Address - Street 1:1200 S YORK ST STE 4180
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5630
Practice Address - Country:US
Practice Address - Phone:331-221-9004
Practice Address - Fax:331-221-3998
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147.000841231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist