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General NPI Number Information
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NPI Number | 1083011845
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Entity Type | Organization
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Legal Business Name | WELL WITH MY SOUL HOLISTIC HEALTH CENTER
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Dates
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Enumeration Date | 11/21/2014
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Last Update Date | 09/03/2024
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Provider Practice Location Address
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Address Line | 9500 S DORCHESTER AVE # 100
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City | CHICAGO
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State | IL
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Zip | 60628-1700
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Country | US
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Telephone | 773-978-6145
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Fax | 773-913-1792
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Provider Business Mailing Address
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Address Line | 8149 S BLACKSTONE AVE
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City | CHICAGO
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State | IL
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Zip | 60619-4616
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Country | US
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Telephone | 773-978-6145
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SOONITI JEANETTE WEEMS
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Credential | DN, LCSW, LMT
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Telephone | 773-978-6145
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2081N0008X
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Taxonomy Name | Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 172P00000X
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Taxonomy Name | Naprapath
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License Number |
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License Number State |
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