Provider Demographics
NPI:1487299780
Name:JENNIFER J. BORTZ PH.D., PLLC
Entity type:Organization
Organization Name:JENNIFER J. BORTZ PH.D., PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:PEYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-717-4215
Mailing Address - Street 1:34522 N SCOTTSDALE RD STE 120-227
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85266-1224
Mailing Address - Country:US
Mailing Address - Phone:480-795-4787
Mailing Address - Fax:480-795-7778
Practice Address - Street 1:2929 E CAMELBACK RD STE 114
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4425
Practice Address - Country:US
Practice Address - Phone:480-795-4787
Practice Address - Fax:480-795-7778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-10
Last Update Date:2019-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty