DR. ROBERT CORNELL VAN SICLEN (NPI# 1871674978) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871674978 |
| Entity Type | Individual |
| Full Name | DR. ROBERT CORNELL VAN SICLEN |
| Credential | PHD |
| Practice Address |
277 Coon Rapids Blvd Nw Suite 308 Coon Rapids MN 55433-5843 |
| Mailing Address |
277 Coon Rapids Boulevard Suite 308 Coon Rapids MN 55433-5843 |
| Practice Telephone | 7637174979 |
| Practice Fax Number | 7637174954 |
| Mailing Telephone | 7637174979 |
| Mailing Fax Number | 7637174954 |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 103T00000X | Psychologist | LP2775 | MN | Behavioral Health & Social Service Providers |
| X | 103TB0200X |
Psychologist Specialization: Cognitive & Behavioral |
LP2775 | MN | Behavioral Health & Social Service Providers |
| X | 103TC0700X |
Psychologist Specialization: Clinical |
LP2775 | MN | Behavioral Health & Social Service Providers |
| X | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
LP2775 | MN | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | UCARE PROVIDER NUMBER | 108029 | 01 |
| MN | BLUE CROSS BLUE SHIELD | 3K444VA | 01 |
| MN | UNITED BEHAVIORAL HEALTH | 61-20060 | 01 |
| Street Address |
277 COON RAPIDS BLVD NW SUITE 308 |
| City | COON RAPIDS |
| State | MN |
| Zip Code | 55433-5843 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912376526 | Myatu Abraham | Technician | 277 Coon Rapids Blvd Nw, Suite 410, Coon Rapids, MN 55433-5843 | 2015-09-24 |
| 1427239847 | Janet Carol Stam I | Psychologist | 277 Coon Rapids Blvd Nw, Suite 115, Coon Rapids, MN 55433-5843 | 2007-11-15 |
| 1225187941 | Jodi Lee Helseth | Counselor | 277 Coon Rapids Blvd Nw, Suite 402, Coon Rapids, MN 55433-5843 | 2007-01-10 |
| 1740348283 | Bonnie Inez Norsted | Counselor | 277 Coon Rapids Blvd Nw, Suite 308, Coon Rapids, MN 55433-5843 | 2006-12-05 |
| 1992876064 | Teresa Josephine Connelly | Counselor | 277 Coon Rapids Blvd Nw, Suite 308, Coon Rapids, MN 55433-5843 | 2006-11-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770134793 | Shelley Karee Peterson | Technician | 10311 Bittersweet St Nw, Coon Rapids, MN 55433 | 2019-09-20 |
| 1578122057 | Courtney Gau | Behavior Technician | Fraser Coon Rapids, 9120 Springbrook Dr. Nw, Coon Rapids, MN 55433 | 2019-06-10 |
| 1992275606 | Maliki Fofee Kamara | Licensed Practical Nurse | 2451 109th Ave Nw Apt. 1, Coon Rapids, MN 55433 | 2018-11-26 |
| 1992284541 | Sarah Vennes | Massage Therapist | 6400 Flying Cloud Dr, Suite 240, Eden Prairie, MN 55433 | 2018-08-13 |
| 1538646609 | Paige Prince | Behavior Technician | Fraser Coon Rapids, 9120 Springbrook Drive Nw, Coon Rapids, MN 55433 | 2018-07-23 |
| 1154828242 | Karin Lea Englund | Dentist | 9145 Springbrook Dr Nw Ste 100, Coon Rapids, MN 55433 | 2018-04-06 |
| 1235642513 | Vista Family Eye Care LLC | Optometrist | 9920 Foley Blvd Nw Ste 120, Coon Rapids, MN 55433 | 2017-11-09 |
| 1538697818 | Mohammed Nmn Ahmed | Internal Medicine | 9055 Spring Brook Drive, Allina Coon Rapids Clinic 9055, Coon Rapids, MN 55433 | 2017-05-31 |
| 1639531353 | Journi LLC | Nurse Practitioner | 277 Coon Rapids Blvd Suite 308, Coon Rapids, MN 55433 | 2016-03-22 |
| 1821457722 | Honorine Boyce | Licensed Practical Nurse | 2743 111th Ave. Nw, Coon Rapids, MN 55433 | 2016-02-19 |
| Find all providers in zip 55433 | ||||
| Taxonomy Code | 103T00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public. |
| Notes: Source: American Psychological Association [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639232804 | Nancy Marie Cusack | Psychologist | 425 Coon Rapids Blvd Nw Ste 200, Suite 100, Coon Rapids, MN 55433-2753 | 2006-12-19 |
| 1710053301 | Michael Hitzelberger | Psychologist | 425 Coon Rapids Blvd #200, Nscc, Coon Rapids, MN 58433 | 2006-11-27 |
| 1518033109 | Julie L Weekley | Psychologist | 425 Coon Rapids Blvd # 200, Nscc, Coon Rapids, MN 55433 | 2006-11-27 |
| 1225102973 | Linda Jean Hawkins | Psychologist | 551 Coon Rapids Blvd, 150, Coon Rapids, MN 55433-5520 | 2006-11-17 |
| 1093777591 | Catherine Jane Luitjens | Psychologist | 11660 Round Lake Blvd Nw, Coon Rapids, MN 55433 | 2006-04-03 |
| 1477537678 | Luann Lengas Heim | Psychologist | 1930 Coon Rapids Boulevard, Family Life Mental Health Center, Coon Rapids, MN 55433 | 2005-12-01 |
| 1093230088 | Jarett Edward Roseberry | Psychologist | 11850 Blackfoot St Nw Ste 400, Coon Rapids, MN 55433-2776 | 2017-08-10 |
| 1225379381 | Linda Rae Deters | Psychologist | 9055 Springbrook Dr Nw, Coon Rapids, MN 55433-5841 | 2013-03-13 |
| 1023361292 | Rand Ollen Adams | Psychologist | 1930 Coon Rapids Blvd Nw, Family Life Mental Health, Coon Rapids, MN 55433-4708 | 2012-10-24 |
| 1962687624 | Andrea Loveless | Psychologist | 9055 Springbrook Dr Nw, Coon Rapids, MN 55433-5841 | 2007-12-31 |
| Find all providers in COON RAPIDS | ||||
| City | COON RAPIDS |
| Zip Code | 55433 |
Please comment or provide details below to improve the information on DR. ROBERT CORNELL VAN SICLEN.
| 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.