Healthcare Provider Details

I. General information

NPI: 1568314946
Provider Name (Legal Business Name): NEW ROOTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2026
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2435 KIMBERLY RD STE 100N
BETTENDORF IA
52722-3511
US

IV. Provider business mailing address

2435 KIMBERLY RD STE 100N
BETTENDORF IA
52722-3511
US

V. Phone/Fax

Practice location:
  • Phone: 309-236-1336
  • Fax: 309-236-1336
Mailing address:
  • Phone: 309-236-1336
  • Fax: 309-236-1336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. LAUREN A. ISAACSON
Title or Position: THERAPIST/OWNER
Credential: LMHC
Phone: 309-236-1336