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General NPI Number Information
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NPI Number | 1275951386
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Entity Type | Individual
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Provider Name | MARJORIE LYNN FUNK PSY.D., ED.S.
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Gender | Female
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Dates
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Enumeration Date | 04/04/2014
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Last Update Date | 04/04/2014
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Provider Practice Location Address
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Address Line | 115 S LUDLOW ST
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City | DAYTON
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State | OH
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Zip | 45402-1812
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Country | US
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Telephone | 934-542-3409
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Fax |
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Provider Business Mailing Address
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Address Line | 639 LINDEMANN DR
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City | MASON
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State | OH
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Zip | 45040-1532
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Country | US
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Telephone | 513-262-2891
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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