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General NPI Number Information
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NPI Number | 1679115745
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Entity Type | Individual
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Provider Name | DALTON RADABAUGH
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Gender | Male
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Dates
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Enumeration Date | 10/10/2019
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 59 GRANT ST
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City | NEWARK
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State | OH
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Zip | 43055-3939
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Country | US
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Telephone | 740-349-7511
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Fax | 740-522-4263
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Provider Business Mailing Address
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Address Line | 59 GRANT ST
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City | NEWARK
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State | OH
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Zip | 43055-3939
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Country | US
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Telephone | 740-349-7511
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Fax | 740-522-4263
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S1904254
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License Number State | OH
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