Provider Demographics
NPI:1104101153
Name:FUNK, MEGGIN DONN (CCC, SLP)
Entity type:Individual
Prefix:MRS
First Name:MEGGIN
Middle Name:DONN
Last Name:FUNK
Suffix:
Gender:F
Credentials:CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 780
Mailing Address - Street 2:609 EAST 3RD STREET
Mailing Address - City:RUSHVILLE
Mailing Address - State:NE
Mailing Address - Zip Code:69360-0780
Mailing Address - Country:US
Mailing Address - Phone:308-207-5507
Mailing Address - Fax:
Practice Address - Street 1:609 EAST 3RD STREET
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:NE
Practice Address - Zip Code:69360-0780
Practice Address - Country:US
Practice Address - Phone:308-207-5507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1196235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist