Active NPI
Jon Jay Vandoren, PH. D.
- Clinical Neuropsychologist
- Phoenix, AZ
National Provider Identifier
1114072220
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- 2081
- Practice address
- 7330 N 16TH St Ste A120
Phoenix, AZ 85020-8201 - Phone
- (480) 699-6968
- Fax
- (480) 666-4803
- NPI assigned
- Jan 25, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 7
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2081 | AZ | |
| Psychologist | 103T00000X | 2081 | AZ | |
| Adult Development & Aging Psychologist | 103TA0700X | 2081 | AZ | |
| Cognitive & Behavioral Psychologist | 103TB0200X | 2081 | AZ | |
| Forensic Psychologist | 103TF0200X | 2081 | AZ | |
| Rehabilitation Psychologist | 103TR0400X | 2081 | AZ | |
| Clinical Neuropsychologist | 103G00000X | 2081 | AZ | Primary |
Addresses
Primary practice location
7330 N 16TH St Ste A120
Phoenix, AZ 85020-8201
Mailing address
PO Box 13361
Scottsdale, AZ 85267-3361
Phone (480) 699-6968
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Z60229 | Other | AZ | MEDICARE GROUP PIN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 1, 2024 through Oct 1, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2081 | AZ | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169683200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1756512000000",
"number": "1114072220",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 13361",
"city": "SCOTTSDALE",
"state": "AZ",
"postal_code": "852673361",
"telephone_number": "480-699-6968",
"fax_number": "480-666-4803"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7330 N 16TH ST STE A120",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850208201",
"telephone_number": "480-699-6968",
"fax_number": "480-666-4803"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDOREN",
"first_name": "JON",
"middle_name": "JAY",
"name_prefix": "Dr.",
"credential": "PH. D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-25",
"last_updated": "2025-08-30",
"certification_date": "2025-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "AZ",
"license": "2081",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "AZ",
"license": "2081",
"primary": false
},
{
"code": "103TA0700X",
"taxonomy_group": "",
"desc": "Psychologist, Adult Development & Aging",
"state": "AZ",
"license": "2081",
"primary": false
},
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "AZ",
"license": "2081",
"primary": false
},
{
"code": "103TF0200X",
"taxonomy_group": "",
"desc": "Psychologist, Forensic",
"state": "AZ",
"license": "2081",
"primary": false
},
{
"code": "103TR0400X",
"taxonomy_group": "",
"desc": "Psychologist, Rehabilitation",
"state": "AZ",
"license": "2081",
"primary": false
},
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "AZ",
"license": "2081",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP PIN",
"identifier": "Z60229",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.