Provider Demographics
NPI:1538057609
Name:SOULU
Entity type:Organization
Organization Name:SOULU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:B
Authorized Official - Last Name:SHEMANO-KRUPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-478-6000
Mailing Address - Street 1:3557 W PETERSON AVE STE 122
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-3218
Mailing Address - Country:US
Mailing Address - Phone:773-478-6000
Mailing Address - Fax:773-478-6516
Practice Address - Street 1:3557 W PETERSON AVE STE 122
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3218
Practice Address - Country:US
Practice Address - Phone:773-478-6000
Practice Address - Fax:773-478-6516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-26
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health