Provider Demographics
NPI:1710624481
Name:VAN SICLEN, TALIA (MA, BCBA)
Entity type:Individual
Prefix:
First Name:TALIA
Middle Name:
Last Name:VAN SICLEN
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14949 FLORENCE TRL STE 100&200
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-4716
Mailing Address - Country:US
Mailing Address - Phone:952-960-8985
Mailing Address - Fax:
Practice Address - Street 1:15025 ATHENRY BAY
Practice Address - Street 2:
Practice Address - City:ROSEMOUNT
Practice Address - State:MN
Practice Address - Zip Code:55068-3506
Practice Address - Country:US
Practice Address - Phone:952-960-8985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-16
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst