Provider Demographics
NPI:1093555716
Name:VAN BOSCH, JENNA (AUD)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:VAN BOSCH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 GOLD HILL RD STE 104
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8988
Mailing Address - Country:US
Mailing Address - Phone:803-620-8250
Mailing Address - Fax:803-638-6901
Practice Address - Street 1:870 GOLD HILL RD STE 104
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8988
Practice Address - Country:US
Practice Address - Phone:803-620-8250
Practice Address - Fax:803-638-6901
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7971237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter