Provider Demographics
NPI:1114072220
Name:VANDOREN, JON JAY (PH D)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:JAY
Last Name:VANDOREN
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10613 N HAYDEN RD STE J108
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-5576
Mailing Address - Country:US
Mailing Address - Phone:480-699-6968
Mailing Address - Fax:480-666-4803
Practice Address - Street 1:10613 N HAYDEN RD STE J108
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-5576
Practice Address - Country:US
Practice Address - Phone:480-699-6968
Practice Address - Fax:480-666-4803
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2081103TC0700X, 103TF0200X, 103TP2701X, 103TR0400X, 103G00000X, 103T00000X, 103TA0700X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ60229OtherMEDICARE GROUP PIN
AZZ60231Medicare PIN