MEDICARE: DR. JENNIFER J BORTZ PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	2060	AZ
2	103G00000X	Clinical Neuropsychologist	2060	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	680011757	OTHER	AZ	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	86080015085259A620	OTHER	AZ	TRIWEST
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306823810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER J BORTZ PHD

Provider Business Mailing Address
First Line	:	34522 N SCOTTSDALE RD STE 120-227
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85266-1224
Country	:	US
Telephone Number	:	480-795-4787
Fax Number	:	480-795-7778

Provider Business Practice Location Address
First Line	:	2929 E CAMELBACK RD
Second Line	:	STE 114
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4425
Country	:	US
Telephone Number	:	480-795-4787
Fax Number	:	480-795-7778

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2005
Last Update Date	:	12/01/2019

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Directions to “ DR. JENNIFER J BORTZ PHD” Practice Location

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