Healthcare Provider Details

I. General information

NPI: 1033026984
Provider Name (Legal Business Name): SOCIAL WELLNESS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 MARLBOROUGH ST APT 101
BOSTON MA
02115-1559
US

IV. Provider business mailing address

416 MARLBOROUGH ST APT 101
BOSTON MA
02115-1559
US

V. Phone/Fax

Practice location:
  • Phone: 203-561-1799
  • Fax:
Mailing address:
  • Phone: 203-561-1799
  • 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: SHELBY SOULE
Title or Position: OWNER, SPEECH THERAPIST
Credential: M.S. CCC SLP
Phone: 203-561-1799