Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Jan Tyson Roberts, PHD

Individual provider Clinical Psychologist · NPI 1265724561

Jan Tyson Roberts, PHD is a Clinical Psychologist in St Louis Park, Minnesota. Qualified in 2006, 20 years ago. Practices as a sole proprietor and accepts Medicare assignment. Licensed in Minnesota.

Years since qualifying
20
Licensed in
MN
In the registry since
2011
What do these letters mean?
PHD — Doctor of Philosophy
A research doctorate. In healthcare it usually sits alongside a clinical licence.

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Practice location Address checks out

5353 Gamble Dr Ste 395
St Louis Park, MN 55416-1510
Phone: (612) 367-7103
Fax: (952) 925-5972
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Psychologist (primary) Taxonomy 103TC0700X · Licence 5330 (MN)

Record details

NPI number1265724561
Entity typeIndividual (Type 1)
GenderFemale
Credentials PHD
Sole proprietorYes
NPI enumeratedMay 5, 2011
Last updated in NPPESJanuary 10, 2018

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL PSYCHOLOGIST
Medical schoolOTHER
Graduated 2006 (20 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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