Provider Demographics
NPI:1679396105
Name:SOL SPEAL LLC
Entity type:Organization
Organization Name:SOL SPEAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYER
Authorized Official - Prefix:
Authorized Official - First Name:KENNEDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BALER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-677-0494
Mailing Address - Street 1:6218 SOUTHWOOD AVE APT 2W
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3231
Mailing Address - Country:US
Mailing Address - Phone:314-677-0494
Mailing Address - Fax:
Practice Address - Street 1:6218 SOUTHWOOD AVE APT 2W
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-3231
Practice Address - Country:US
Practice Address - Phone:314-677-0494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty