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General NPI Number Information
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NPI Number | 1124211826
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Entity Type | Organization
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Legal Business Name | JON VAN DOREN, PH.D., PLLC
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Dates
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Enumeration Date | 08/26/2007
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Last Update Date | 08/30/2025
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Provider Practice Location Address
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Address Line | 7330 N 16TH ST STE A120
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City | PHOENIX
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State | AZ
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Zip | 85020-8201
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Country | US
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Telephone | 480-699-6968
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Fax | 480-666-4803
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Provider Business Mailing Address
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Address Line | PO BOX 13361
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City | SCOTTSDALE
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State | AZ
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Zip | 85267-3361
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Country | US
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Telephone | 480-699-6968
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Fax | 480-666-4803
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Authorized Official
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Title or Position | SOLE PROPRIETOR, NEUROPSYCHOLOGIST
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Name | DR. JON JAY VANDOREN
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Credential | PH.D.
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Telephone | 480-699-6968
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 2081
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License Number State | AZ
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