Provider Demographics
NPI:1235537945
Name:BOSSE, ISAAC DONALD SR (BS)
Entity Type:Individual
Prefix:MR
First Name:ISAAC
Middle Name:DONALD
Last Name:BOSSE
Suffix:SR
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4115 WELLINGTON WOODS CIR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-2750
Mailing Address - Country:US
Mailing Address - Phone:407-483-8369
Mailing Address - Fax:
Practice Address - Street 1:4115 WELLINGTON WOODS CIR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-2750
Practice Address - Country:US
Practice Address - Phone:407-483-8369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL59-3595260103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst