Healthcare Provider Details

I. General information

NPI: 1306823810
Provider Name (Legal Business Name): JENNIFER J BORTZ PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2005
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 TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2060
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number2060
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: