Provider Demographics
NPI:1023334190
Name:FUNK, JUDY MAY (LCSW)
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:MAY
Last Name:FUNK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10042 KNOX DR
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-5339
Mailing Address - Country:US
Mailing Address - Phone:913-980-4975
Mailing Address - Fax:
Practice Address - Street 1:10042 KNOX DR
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-5339
Practice Address - Country:US
Practice Address - Phone:913-894-2734
Practice Address - Fax:913-894-2734
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20090376971041C0700X
KS18861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical