Lifeskills Connection Inc.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

LIFESKILLS CONNECTION INC.

Practice address

1500 W 3Rd St
Manning, IA 51455-1810

Phone

(563) 370-7995

Fax

(563) 888-1350

NPI assigned

Oct 22, 2018

Organization subpart

No

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

Authorized official

Name

Robin Butler

Title

Credentialling Specialist

Phone

(563) 370-7995

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• HOLISTIC HEALTH Doing business as

Medicare fee-for-service enrollment

Enrolled in IA

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Britney Marie Randolph, LMSW

  • Clinical Social Worker
  • Harlan, IA
  • NPI 1558927061

  Clinical, IA

  Medicare reassignment NPD
• Penny Kain, LCSW

  • Clinical Social Worker
  • Rock Island, IL
  • NPI 1760492292

  Clinical, IA

  Medicare reassignment NPD
• Candice J. Kundert, L.I.S.W.; L.C.S.W.

  • Clinical Social Worker
  • Davenport, IA
  • NPI 1063426328

  Clinical

  NPD (past)

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

{
    "created_epoch": "1540166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726704000000",
    "number": "1295201754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 W 3RD ST",
            "city": "MANNING",
            "state": "IA",
            "postal_code": "514551810",
            "telephone_number": "833-311-1661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 W 3RD ST",
            "city": "MANNING",
            "state": "IA",
            "postal_code": "514551810",
            "telephone_number": "563-370-7995",
            "fax_number": "563-888-1350"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2435 Kimberly Rd",
            "address_purpose": "LOCATION",
            "city": "Bettendorf",
            "state": "IA",
            "postal_code": "527223509",
            "country_code": "US",
            "telephone_number": "563-370-7995",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LIFESKILLS CONNECTION INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-22",
        "last_updated": "2024-09-19",
        "certification_date": "2024-09-19",
        "status": "A",
        "authorized_official_last_name": "BUTLER",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_title_or_position": "CREDENTIALLING SPECIALIST",
        "authorized_official_telephone_number": "563-370-7995"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALL OTHER INSURANCE COMPANIES",
            "identifier": "1760492292",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1558927061",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1760492292",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALL OTHER INSURANCE COMPANIES",
            "identifier": "1558927061",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HOLISTIC HEALTH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Michelle Marie Kroeger, ARNP, MSN
• Dalton Timothy Lytle, CADC
• Manning Betterment Foundation
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• Manning Dental LLC
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• All providers in Manning, IA
• Clinical Social Worker in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.