Healthcare Provider Details

I. General information

NPI: 1639008022
Provider Name (Legal Business Name): ROOTED WITHIN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 8TH ST STE 202
BOONE IA
50036-2921
US

IV. Provider business mailing address

915 8TH ST STE 202
BOONE IA
50036-2921
US

V. Phone/Fax

Practice location:
  • Phone: 515-626-6091
  • Fax:
Mailing address:
  • Phone: 515-626-6091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JUSTINE CHANTELLE ANDERSON
Title or Position: SOCIAL WORKER
Credential: LISW
Phone: 515-626-6091