Individual
JAN TYSON ROBERTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
5353 GAMBLE DR STE 395, ST LOUIS PARK, MN 55416-1510
(612) 367-7103
(952) 925-5972
Mailing address
5353 GAMBLE DR STE 395, ST LOUIS PARK, MN 55416-1510
(612) 367-7103
(952) 925-5972
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
5330
MN
Other
Enumeration date
05/05/2011
Last updated
01/10/2018
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