Healthcare Provider Details

I. General information

NPI: 1346158474
Provider Name (Legal Business Name): TIMEOUT BEHAVIOR COACHING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 17TH PL SE
ROCHESTER MN
55904-5621
US

IV. Provider business mailing address

PO BOX 8536
ROCHESTER MN
55903-8536
US

V. Phone/Fax

Practice location:
  • Phone: 507-272-2269
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: RYAN IHRKE
Title or Position: HR / FINANCE DIRECTOR
Credential:
Phone: 507-272-2269