Provider Demographics
NPI:1568200426
Name:GOETZ, ALYCE M
Entity type:Individual
Prefix:
First Name:ALYCE
Middle Name:M
Last Name:GOETZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:WASHBURN
Mailing Address - State:ND
Mailing Address - Zip Code:58577-0070
Mailing Address - Country:US
Mailing Address - Phone:701-462-3581
Mailing Address - Fax:701-462-3590
Practice Address - Street 1:712 5TH AVE
Practice Address - Street 2:
Practice Address - City:WASHBURN
Practice Address - State:ND
Practice Address - Zip Code:58577-4352
Practice Address - Country:US
Practice Address - Phone:701-462-3581
Practice Address - Fax:701-462-3590
Is Sole Proprietor?:No
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator