Healthcare Provider Details

I. General information

NPI: 1629380662
Provider Name (Legal Business Name): JOSHUA WADE STEWART
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: WADE STEWART

II. Dates (important events)

Enumeration Date: 07/07/2010
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2135 PINE ST
REDDING CA
96001-2690
US

IV. Provider business mailing address

21918 BELMONT DR
PALO CEDRO CA
96073-8738
US

V. Phone/Fax

Practice location:
  • Phone: 530-722-9957
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: