Healthcare Provider Details

I. General information

NPI: 1275951386
Provider Name (Legal Business Name): MARJORIE LYNN FUNK PSY.D., ED.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2014
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 COTTINGHAM DR
CINCINNATI OH
45241-1616
US

IV. Provider business mailing address

639 LINDEMANN DR
MASON OH
45040-1532
US

V. Phone/Fax

Practice location:
  • Phone: 513-864-1035
  • Fax:
Mailing address:
  • Phone: 513-262-2891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLSP.00516
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: