Provider Demographics
NPI:1508254897
Name:SOLES THERAPY SERVICES CORP
Entity Type:Organization
Organization Name:SOLES THERAPY SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:BLANCA
Authorized Official - Middle Name:ANTONIA
Authorized Official - Last Name:ARENAS
Authorized Official - Suffix:
Authorized Official - Credentials:MHS
Authorized Official - Phone:708-602-1129
Mailing Address - Street 1:713 N. ADELE STREET
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126
Mailing Address - Country:US
Mailing Address - Phone:708-602-1129
Mailing Address - Fax:
Practice Address - Street 1:627 N YORK STREET
Practice Address - Street 2:UNIT E
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126
Practice Address - Country:US
Practice Address - Phone:708-602-1129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-08
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========6016401Medicaid