Individual
DR. ROBERT CORNELL VAN SICLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
277 COON RAPIDS BLVD NW, SUITE 308, COON RAPIDS, MN 55433-5843
(763) 717-4979
(763) 717-4954
Mailing address
277 COON RAPIDS BOULEVARD, SUITE 308, COON RAPIDS, MN 55433-5843
(763) 717-4979
(763) 717-4954
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
LP2775
MN
103TB0200X
Cognitive & Behavioral Psychologist
LP2775
MN
103TC0700X
Clinical Psychologist
Primary
LP2775
MN
103TC2200X
Clinical Child & Adolescent Psychologist
LP2775
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
108029
UCARE PROVIDER NUMBER
MN
01
—
3K444VA
BLUE CROSS BLUE SHIELD
MN
01
—
61-20060
UNITED BEHAVIORAL HEALTH
MN
Enumeration date
10/17/2006
Last updated
09/11/2025
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