Provider Demographics
NPI:1811046733
Name:GATT, JENNIFER T (PHD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:T
Last Name:GATT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:301 E BETHANY HOME RD
Mailing Address - Street 2:STE A301
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1263
Mailing Address - Country:US
Mailing Address - Phone:602-230-8324
Mailing Address - Fax:602-274-7402
Practice Address - Street 1:301 E BETHANY HOME RD
Practice Address - Street 2:STE A301
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1263
Practice Address - Country:US
Practice Address - Phone:602-230-8324
Practice Address - Fax:602-274-7402
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ3564103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist