Active NPI
Robert Cornell Van Siclen, PHD
- Clinical Psychologist
- Coon Rapids, MN
National Provider Identifier
1871674978
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- LP2775
- Practice address
- 277 Coon Rapids Blvd NW
Suite 308
Coon Rapids, MN 55433-5843 - Phone
- (763) 717-4979
- Fax
- (763) 717-4954
- NPI assigned
- Oct 17, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cognitive & Behavioral Psychologist | 103TB0200X | LP2775 | MN | |
| Clinical Psychologist | 103TC0700X | LP2775 | MN | Primary |
| Clinical Child & Adolescent Psychologist | 103TC2200X | LP2775 | MN | |
| Psychologist | 103T00000X | LP2775 | MN |
Addresses
Primary practice location
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
Phone (763) 717-4979
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3K444VA | Other | MN | BLUE CROSS BLUE SHIELD |
| 108029 | Other | MN | UCARE PROVIDER NUMBER |
| 61-20060 | Other | MN | UNITED BEHAVIORAL HEALTH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP2775 | MN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1871674978",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "277 COON RAPIDS BOULEVARD",
"address_2": "SUITE 308",
"city": "COON RAPIDS",
"state": "MN",
"postal_code": "554335843",
"telephone_number": "763-717-4979",
"fax_number": "763-717-4954"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "277 COON RAPIDS BLVD NW",
"address_2": "SUITE 308",
"city": "COON RAPIDS",
"state": "MN",
"postal_code": "554335843",
"telephone_number": "763-717-4979",
"fax_number": "763-717-4954"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN SICLEN",
"first_name": "ROBERT",
"middle_name": "CORNELL",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-17",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "MN",
"license": "LP2775",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "LP2775",
"primary": true
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "MN",
"license": "LP2775",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MN",
"license": "LP2775",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "3K444VA",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE PROVIDER NUMBER",
"identifier": "108029",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED BEHAVIORAL HEALTH",
"identifier": "61-20060",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Coon Rapids, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.