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General NPI Number Information
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NPI Number | 1912288143
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Entity Type | Individual
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Provider Name | ROBERT J FUNCHEON LSCSW
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Gender | Male
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Dates
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Enumeration Date | 09/01/2011
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Last Update Date | 11/18/2022
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Provider Practice Location Address
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Address Line | 1855 N WEBB RD
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City | WICHITA
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State | KS
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Zip | 67206-3413
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Country | US
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Telephone | 376-636-2888
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Fax | 316-636-2666
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Provider Business Mailing Address
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Address Line | 6020 FLAGSTAFF ST
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City | BEL AIRE
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State | KS
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Zip | 67220-1863
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Country | US
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Telephone | 316-841-3760
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4501
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License Number State | KS
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