MEDICARE: SOUL SOLACE MASSAGE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1497687115
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUL SOLACE MASSAGE LLC

Provider Business Mailing Address
First Line	:	16372 KENRICK AVE # 120
Second Line	:
City	:	LAKEVILLE
State	:	MN
Zip	:	55044-3540
Country	:	US
Telephone Number	:	612-254-9008
Fax Number	:

Provider Business Practice Location Address
First Line	:	16372 KENRICK AVE # 120
Second Line	:
City	:	LAKEVILLE
State	:	MN
Zip	:	55044-3540
Country	:	US
Telephone Number	:	612-254-9008
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOCELYN LEE SWANSON
Credential	:	LMT
Telephone Number	:	612-254-9008

Provider Enumeration Date	:	05/29/2026
Last Update Date	:	05/29/2026

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Directions to “SOUL SOLACE MASSAGE LLC ” Practice Location

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