Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 2081 | AZ |
Y | 103TC0700X | Clinical Psychologist | 2081 | AZ |
N | 102L00000X | Psychologist | 2081 | AZ |
N | 103T00000X | Psychologist | 2081 | AZ |
N | 103TA0700X | Adult Development & Aging Psychologist | 2081 | AZ |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 2081 | AZ |
N | 103G00000X | Clinical Psychologist | 2081 | AZ |
N | 103TC0700X | Clinical Psychologist | 2081 | AZ |
N | 103TF0200X | Forensic Psychologist | 2081 | AZ |
N | 103TP2701X | Group Psychotherapist | 2081 | AZ |
N | 103TR0400X | Rehabilitation Psychologist | 2081 | AZ |
NPI | 1114072220 |
---|---|
Provider Name | Jon Jay Vandoren |
First Address | Scottsdale, AZ 85254-4557 |
Second Address | Scottsdale, AZ 85258-1298 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2007 |
Last Update Date | 14/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Z60229 | MEDICARE GROUP PIN (01) | AZ |