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General NPI Number Information
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NPI Number | 1124911011
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Entity Type | Individual
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Provider Name | AMY FUNKHOUSER EDS
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Gender | Female
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Dates
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Enumeration Date | 05/30/2025
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 501 W OLIVE ST
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City | WEST TERRE HAUTE
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State | IN
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Zip | 47885-1822
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Country | US
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Telephone | 812-462-4364
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 S 10TH ST
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City | TERRE HAUTE
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State | IN
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Zip | 47802-3618
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Country | US
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Telephone | 812-201-7224
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 000037823
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License Number State | IN
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