Active NPI
Edwina Bailey, RADT
- Rehabilitation Practitioner
- South Lake Tahoe, CA
National Provider Identifier
1700603909
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Practitioner
- Practice address
- 1693 Nadowa Street
South Lake Tahoe, CA 96150 - Phone
- (623) 889-4711
- NPI assigned
- Sep 20, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | LAAC-15597 | AZ | |
| Health Educator | 174H00000X | |||
| Case Manager/Care Coordinator | 171M00000X | |||
| Rehabilitation Practitioner | 225400000X | Primary |
Addresses
Primary practice location
1693 Nadowa Street
South Lake Tahoe, CA 96150
Mailing address
PO Box 770
Happy Camp, CA 96039-0770
Other practice location 1
64105 Hillside Road
Happy Camp, CA 96039
Phone (623) 889-4711
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LAAC-15597 | AZ | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1726790400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1764979200000",
"number": "1700603909",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 770",
"city": "HAPPY CAMP",
"state": "CA",
"postal_code": "960390770"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1693 NADOWA STREET",
"city": "SOUTH LAKE TAHOE",
"state": "CA",
"postal_code": "96150",
"telephone_number": "623-889-4711"
}
],
"practiceLocations": [
{
"address_1": "64105 Hillside Road",
"address_purpose": "LOCATION",
"city": "Happy Camp",
"state": "CA",
"postal_code": "96039",
"country_code": "US",
"telephone_number": "623-889-4711",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BAILEY",
"first_name": "EDWINA",
"credential": "RADT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-09-20",
"last_updated": "2025-12-06",
"certification_date": "2025-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "AZ",
"license": "LAAC-15597",
"primary": false
},
{
"code": "174H00000X",
"taxonomy_group": "",
"desc": "Health Educator",
"state": null,
"license": null,
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": false
},
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Lake Tahoe, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.