Jenna Viditz-Ward, AUD

Primary specialty

AudiologistTaxonomy code 231H00000X

License

7971 Issued in SC

Practice address

870 Gold Hill Rd Ste 104
Fort Mill, SC 29708-8988

Phone

(803) 620-8250

Fax

(803) 638-6901

NPI assigned

May 30, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Jenna M Van Bosch Former name

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Specialty

Qualified Audiologist

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lakeside Audiology LLCGroup PAC ID 3870812159, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lakeside Audiology LLC

  • Hearing and Speech Clinic/Center
  • Fort Mill, SC
  • NPI 1417341280

  Audiologist

  Medicare reassignment Care Compare group NPD
• Lakeside Audiology LLC

  dba Hearing Zone

  • Audiologist-Hearing Aid Fitter
  • Layton, UT
  • NPI 1336454958
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1717027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765929600000",
    "number": "1093555716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "870 GOLD HILL RD STE 104",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297088988",
            "telephone_number": "803-620-8250",
            "fax_number": "803-638-6901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "870 GOLD HILL RD STE 104",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297088988",
            "telephone_number": "803-620-8250",
            "fax_number": "803-638-6901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIDITZ-WARD",
        "first_name": "JENNA",
        "credential": "AUD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-30",
        "last_updated": "2025-12-17",
        "certification_date": "2025-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "SC",
            "license": "7971",
            "primary": true
        },
        {
            "code": "237600000X",
            "taxonomy_group": "",
            "desc": "Audiologist-Hearing Aid Fitter",
            "state": "SC",
            "license": "7971",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNA",
            "last_name": "VAN BOSCH",
            "middle_name": "M",
            "credential": "AU.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Audiologist in Fort Mill, SC
• Providers in Fort Mill, SC by specialty
• Audiologist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.