Healthcare Provider Details

I. General information

NPI: 1548948664
Provider Name (Legal Business Name): KATHERINE FUNK MM, MT-BC, NMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7080 N 19TH AVE
PHOENIX AZ
85021-8585
US

IV. Provider business mailing address

7223 N 73RD DR
GLENDALE AZ
85303-2572
US

V. Phone/Fax

Practice location:
  • Phone: 480-826-1463
  • Fax:
Mailing address:
  • Phone: 303-482-6136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number11885
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: