Provider Demographics
NPI:1104629930
Name:JUNKER, DANA RENAE (DI)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:RENAE
Last Name:JUNKER
Suffix:
Gender:
Credentials:DI
Other - Prefix:MRS
Other - First Name:DANA
Other - Middle Name:RENAE
Other - Last Name:BEATTIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:502 FOREGO TRL
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-8507
Mailing Address - Country:US
Mailing Address - Phone:606-280-0177
Mailing Address - Fax:
Practice Address - Street 1:502 FOREGO TRL
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-8507
Practice Address - Country:US
Practice Address - Phone:606-280-0177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY200220497252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency