| Soulspire, LLC | |
|
17508 Minnetonka Blvd Minnetonka MN 55345-1007 | |
| (763) 234-4876 | |
| Not Available |
| Full Name | Soulspire, LLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 17508 Minnetonka Blvd, Minnetonka, Minnesota |
| Authorized Official Name and Position | Susan Powers Olson (ORGANIZER) |
| Authorized Official Contact | 7632344876 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Soulspire, LLC 17508 Minnetonka Blvd Minnetonka MN 55345-1007 Ph: (763) 234-4876 | Soulspire, LLC 17508 Minnetonka Blvd Minnetonka MN 55345-1007 Ph: (763) 234-4876 |
| NPI Number | 1316731599 |
|---|---|
| Provider Enumeration Date | 04/04/2025 |
| Last Update Date | 04/04/2025 |
| Certification Date | 04/04/2025 |
| Medicare PECOS PAC ID | 0446739171 |
|---|---|
| Medicare Enrollment ID | O20260212000102 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316731599 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | () | Primary |
| Provider Name | Susan Powers |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1053325175 PECOS PAC ID: 7315995594 Enrollment ID: I20050104000846 |
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