Rooted Mind & Body LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

ROOTED MIND & BODY LLC

Practice address

N1547 Overlook Dr
Genoa City, WI 53128-1592

Phone

(815) 575-9559

NPI assigned

Jul 14, 2026

Last updated

Jul 14, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Matthew Fetrow, LCSW

Title

Owner

Phone

(815) 575-9559

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1783987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783987200000",
    "number": "1780503441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N1547 OVERLOOK DR",
            "city": "GENOA CITY",
            "state": "WI",
            "postal_code": "531281592",
            "telephone_number": "815-575-9559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N1547 OVERLOOK DR",
            "city": "GENOA CITY",
            "state": "WI",
            "postal_code": "531281592",
            "telephone_number": "815-575-9559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROOTED MIND & BODY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-07-14",
        "last_updated": "2026-07-14",
        "certification_date": "2026-07-15",
        "status": "A",
        "authorized_official_last_name": "FETROW",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-575-9559",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Genoa City, WI
• Providers in Genoa City, WI by specialty
• Clinical Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 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.