Carolyn Hollister, LISW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

107365 Issued in IA

Practice address

1605 N Ankeny Blvd Ste 110
Ankeny, IA 50023-4163

Phone

(515) 520-8164

Fax

(515) 209-7756

NPI assigned

Jun 17, 2021

Last updated

Aug 16, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Illuminate Life Therapy, LLC

  • Clinical Social Worker
  • Ankeny, IA
  • NPI 1194408500
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1623888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692144000000",
    "number": "1932778610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1605 N ANKENY BLVD STE 110",
            "city": "ANKENY",
            "state": "IA",
            "postal_code": "500234163",
            "telephone_number": "515-402-1047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1605 N ANKENY BLVD STE 110",
            "city": "ANKENY",
            "state": "IA",
            "postal_code": "500234163",
            "telephone_number": "515-520-8164",
            "fax_number": "515-209-7756"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "213 N Ankeny Blvd",
            "address_purpose": "LOCATION",
            "city": "Ankeny",
            "state": "IA",
            "postal_code": "500231749",
            "country_code": "US",
            "telephone_number": "515-705-0174",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HOLLISTER",
        "first_name": "CAROLYN",
        "credential": "LISW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-17",
        "last_updated": "2023-08-16",
        "certification_date": "2023-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IA",
            "license": "107365",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOCIAL WORK LICENSE",
            "identifier": "107365",
            "state": "IA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "carolyn@illuminatelifetherapy.com",
            "affiliation": "N",
            "endpointDescription": "Business Email",
            "address_1": "1605 N Ankeny Blvd Ste 110",
            "city": "Ankeny",
            "state": "IA",
            "country_code": "US",
            "postal_code": "500234163",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Janet J Hoegh, LMT
• Kyra Alyssa Hoffman, DPT
• Chandler Hohbach
• Holistic Connections Family Therapy, LLC
• Holistic Healing & Counseling LLC
• Marissa S Holloway, PHARMD
• Kelly L Hollstein, PHARMD
• Holm Medical Transport
• Susan M. Holmes Roberts, RDN
• Lauren Elizabeth Holmes, PHARMD

• Clinical Social Worker in Ankeny, IA
• Providers in Ankeny, IA by specialty
• Clinical Social Worker in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.