JAN TYSON ROBERTS (NPI# 1265724561) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265724561 |
| Entity Type | Individual |
| Full Name | JAN TYSON ROBERTS |
| Credential | PH.D. |
| Practice Address |
5353 Gamble Dr Ste 395 St Louis Park MN 55416-1510 |
| Practice Telephone | 6123677103 |
| Practice Fax Number | 9529255972 |
| Mailing Telephone | 6123677103 |
| Mailing Fax Number | 9529255972 |
| Enumeration Date | 2011-05-05 |
| Last Update Date | 2018-01-10 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
5330 | MN | Behavioral Health & Social Service Providers |
| Street Address |
5353 GAMBLE DR STE 395 |
| City | ST LOUIS PARK |
| State | MN |
| Zip Code | 55416-1510 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558412924 | Mary Elizabeth Grosscup | Psychologist | 5353 Gamble Dr Ste 395, St Louis Park, MN 55416-1510 | 2007-01-14 |
| 1639671530 | Richmond Psychological Services, LLC | Psychologist | 5353 Gamble Dr Ste 395, St Louis Park, MN 55416-1510 | 2018-03-06 |
| 1013295526 | Adeya Richmond | Psychologist | 5353 Gamble Dr Ste 395, St Louis Park, MN 55416-1510 | 2011-08-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639711492 | Ismahan Abdirahman Mohamed | Psychologist | 4236 Parkglen Rd, St Louis Park, MN 55416 | 2019-10-14 |
| 1598307860 | Ayman Abulaziz Mohamed | Counselor | 4326 Park Glen Rd, St Louis Park, MN 55416 | 2019-10-08 |
| 1831758929 | Ally Group Homes LLC | Assisted Living Facility | 2944 Princeton Ave South, Saint Louis Park, MN 55416 | 2019-06-11 |
| 1609371525 | Heather Margaret Flatgard | Chiropractor | 5407 Excelsior Blvd Ste D, St Louis Park, MN 55416 | 2018-03-25 |
| 1942702394 | Polaris Pharmacy Services of Minnesota, LLC | Pharmacy | 4220 Park Glen Road, St. Louis Park, MN 55416 | 2018-03-01 |
| 1316469760 | Evert Ray Boyd | Psychologist | 3200 Highway 100 S., Groves Academy, St Louis Park, MN 55416 | 2017-07-07 |
| 1861941684 | Amanda Marie Tapper | Marriage & Family Therapist | 5407 Excelsior Blvd, Suite B, St Louis Park, MN 55416 | 2016-09-22 |
| 1326410416 | Clear Health Chiropractic LLC | Chiropractor | 5614 W 36th St, St. Louis Park, MN 55416 | 2015-10-28 |
| 1568897833 | Kay Elizabeth Lichtenberger | Physical Therapist | 4415 W 36.5 St, St. Louis Park, MN 55416 | 2013-09-05 |
| 1710221510 | Aaron Christopher Oppelt | Counselor | 1665 Utica Ave South - Suite 100, Saint Louis Park, MN 55416 | 2012-11-16 |
| Find all providers in zip 55416 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265768337 | Natalie Marie Marr | Psychologist | 6121 Excelsior Blvd, Ste 101a, St Louis Park, MN 55416-2752 | 2009-10-26 |
| 1205038387 | Alyson Mease Vanahn | Psychologist | 4240 Park Glen Rd, St Louis Park, MN 55416 | 2007-06-01 |
| 1669694550 | Deborah Bushway | Psychologist | Parkdale Plaza, 1660 South Hwy 100, St Louis Park, MN 55427 | 2007-05-02 |
| 1508988981 | Sandra Ruth Streitman | Psychologist | 9031 W 34th St, St Louis Park, MN 55426-3703 | 2007-04-04 |
| 1215055587 | Dawn Elizabeth Mcclelland | Psychologist | 1660 S Hwy 100, #428, St Louis Park, MN 55416 | 2007-03-26 |
| 1770636771 | Lydia Gail Roth-laube | Psychologist | 1660 Highway 100 S Ste 142, St Louis Park, MN 55416-1562 | 2007-01-21 |
| 1033208566 | Sharon Kay Ondich | Psychologist | 5353 Gamble Drive, Suite 108, St Louis Park, MN 55416-1539 | 2006-10-12 |
| 1013970250 | Rachel Jane Allyn | Psychologist | 4200 Minnetonka Blvd, St Louis Park, MN 55416-5191 | 2006-04-10 |
| 1275519795 | David Randal | Psychologist | Park Nicollet Clinic Idc, 3800 Park Nicollet Blvd, St Louis Park, MN 55416 | 2005-12-16 |
| 1265427629 | Renee T Vonweiss | Psychologist | 4500 Park Glen Rd, Suite 450, St Louis Park, MN 55416-4871 | 2005-09-13 |
| Find all providers in ST LOUIS PARK | ||||
| City | ST LOUIS PARK |
| Zip Code | 55416 |
Please comment or provide details below to improve the information on JAN TYSON ROBERTS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.