Healthcare Provider Details

I. General information

NPI: 1508789181
Provider Name (Legal Business Name): SOUL THERAPY SPEECH AND LANGUAGE SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9673 GRAND TETON AVE
BATON ROUGE LA
70814-4014
US

IV. Provider business mailing address

2320 DRUSILLA LN
BATON ROUGE LA
70809-1495
US

V. Phone/Fax

Practice location:
  • Phone: 225-456-4616
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MS. CHIANTAY O'CONNER
Title or Position: SLP
Credential: SLP
Phone: 225-456-4616