=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548194467
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROOTED IN WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2026
-----------------------------------------------------
Last Update Date | 06/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 325 COBBLERS WAY
-----------------------------------------------------
City | WATERLOO
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46793-9489
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-490-6303
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 325 COBBLERS WAY
-----------------------------------------------------
City | WATERLOO
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46793-9489
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-490-6303
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER
-----------------------------------------------------
Name | CAITLYNN EISEL
-----------------------------------------------------
Credential | LMSW
-----------------------------------------------------
Telephone | 260-226-3238
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------