Renewed Rebellion Wellness Company

Primary specialty

Social WorkerTaxonomy code 104100000X

Legal business name

RENEWED REBELLION WELLNESS COMPANY

Practice address

531 Commercial St.
#700
Waterloo, IA 50701

Phone

(319) 988-1413

NPI assigned

Feb 3, 2026

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Carly Lyn Heimerdinger

Title

Lisw

Phone

(319) 988-1413

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1770076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770076800000",
    "number": "1104776558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "531 COMMERCIAL ST.",
            "address_2": "#700",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "50701",
            "telephone_number": "319-988-1413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "531 COMMERCIAL ST.",
            "address_2": "#700",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "50701",
            "telephone_number": "319-988-1413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENEWED REBELLION WELLNESS COMPANY",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-02-03",
        "last_updated": "2026-02-03",
        "status": "A",
        "authorized_official_last_name": "HEIMERDINGER",
        "authorized_official_first_name": "CARLY",
        "authorized_official_middle_name": "LYN",
        "authorized_official_title_or_position": "LISW",
        "authorized_official_telephone_number": "319-988-1413"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.