Van Siclen, Robert Cornell
Van Siclen, Robert Cornell is an sole proprietor health care provider with primary practice located at 277 Coon Rapids Blvd Nw Suite 308, Coon Rapids MN 55433-5843. He recently has 4 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Cognitive & Behavioral, Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Clinical Child & Adolescent, Behavioral Health & Social Service Providers / Psychologist. Behavioral Health & Social Service Providers / Cognitive & Behavioral is his primary health care specialty. Van Siclen, Robert Cornell can be contacted via phone (763) 717-4979.Contact Information
Primary practice address
277 Coon Rapids Blvd Nw Suite 308
Coon Rapids MN 55433-5843
Phone: (763) 717-4979
Fax: (763) 717-4954
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Cognitive & Behavioral | 103TB0200X | LP2775 | Minnesota |
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | LP2775 | Minnesota |
| Behavioral Health & Social Service Providers / Clinical Child & Adolescent | 103TC2200X | LP2775 | Minnesota |
| Behavioral Health & Social Service Providers / Psychologist | 103T00000X | LP2775 | Minnesota |
Profile Details
| NPI number | 1871674978 |
|---|---|
| LBN Legal business name | Van Siclen, Robert Cornell |
| Credentials | PHD |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 17th, 2006 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1871674978 | NPPES |
| Minnesota | Other | 3K444VA | BLUE CROSS BLUE SHIELD |
| Minnesota | Other | 108029 | BLUE CROSS BLUE SHIELD |
| Minnesota | Other | 61-20060 | BLUE CROSS BLUE SHIELD |
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