Provider Demographics
NPI:1134762446
Name:COOLEY, CINDI L
Entity type:Individual
Prefix:
First Name:CINDI
Middle Name:L
Last Name:COOLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9466 COUNTY ROAD 8
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-4848
Mailing Address - Country:US
Mailing Address - Phone:218-232-8260
Mailing Address - Fax:
Practice Address - Street 1:17230 NOOPIMING DR
Practice Address - Street 2:
Practice Address - City:ONAMIA
Practice Address - State:MN
Practice Address - Zip Code:56359-4522
Practice Address - Country:US
Practice Address - Phone:320-532-4181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1012Medicaid