Healthcare Provider Details

I. General information

NPI: 1841978640
Provider Name (Legal Business Name): SOULWORK, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 E 45TH ST APT 1
CHICAGO IL
60653-5163
US

IV. Provider business mailing address

118 E 45TH ST APT 1
CHICAGO IL
60653-5163
US

V. Phone/Fax

Practice location:
  • Phone: 773-451-0100
  • Fax:
Mailing address:
  • Phone: 773-451-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. LASONDA A. WILKINS
Title or Position: CHIEF EXECUTIVE CLINICAL DIRECTOR
Credential: LCSW
Phone: 773-451-0100