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NPI Code Detail

MEDICARE: CYAN KOOS

MEDICARE: CYAN KOOS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1457103954
Entity Type Code : Individual
Provider Name (Legal Business Name) : CYAN KOOS
Provider Business Mailing Address
First Line : 34683 COUNTRY ROAD 72
Second Line :
City : ZUMBRO FALLS
State : MN
Zip : 55991
Country : US
Telephone Number : 218-508-6146
Fax Number :
Provider Business Practice Location Address
First Line : 1470 INDUSTRIAL DR NW
Second Line :
City : ROCHESTER
State : MN
Zip : 55901-0700
Country : US
Telephone Number : 507-322-7750
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2024
Last Update Date : 01/08/2026

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Directions to “ CYAN KOOS ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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