MEDICARE: JON S BOS PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	6301010098	MI
2	103G00000X	Clinical Neuropsychologist	1382	SC
3	103T00000X	Psychologist	202170	AR
4	103TC0700X	Clinical Psychologist	1382	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1922123645	OTHER		NPI
2	680D116880	OTHER	MI	BCBS PROVIDER I.D.

General Provider Information

NPI Number	:	1922123645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JON S BOS PSY.D.

Provider Business Mailing Address
First Line	:	2000 CENTER POINT RD STE 2350
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29210-5826
Country	:	US
Telephone Number	:	803-699-8887
Fax Number	:	803-699-8824

Provider Business Practice Location Address
First Line	:	2000 CENTER POINT RD STE 2350
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29210-5826
Country	:	US
Telephone Number	:	803-699-8887
Fax Number	:	803-699-8824

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	04/24/2025

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Directions to “ JON S BOS PSY.D.” Practice Location

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