Healthcare Provider Details

I. General information

NPI: 1487299780
Provider Name (Legal Business Name): JENNIFER J. BORTZ PH.D., PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2019
Last Update Date: 12/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 E CAMELBACK RD STE 114
PHOENIX AZ
85016-4425
US

IV. Provider business mailing address

34522 N SCOTTSDALE RD STE 120-227
SCOTTSDALE AZ
85266-1224
US

V. Phone/Fax

Practice location:
  • Phone: 480-795-4787
  • Fax: 480-795-7778
Mailing address:
  • Phone: 480-795-4787
  • Fax: 480-795-7778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: SHANNON PEYTON
Title or Position: OFFICE MANAGER
Credential:
Phone: 800-717-4215