Healthcare Provider Details

I. General information

NPI: 1134049372
Provider Name (Legal Business Name): MELODY SUZZANNE STEWART RADT TRAINEE I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 E WALNUT AVE
VISALIA CA
93292-1415
US

IV. Provider business mailing address

1425 E WALNUT AVE
VISALIA CA
93292-1415
US

V. Phone/Fax

Practice location:
  • Phone: 559-625-4072
  • Fax:
Mailing address:
  • Phone: 559-625-4072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRT1444940526
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: