Provider Demographics
NPI:1275246498
Name:GOELZ, SAVANNA ROSE (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:SAVANNA
Middle Name:ROSE
Last Name:GOELZ
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CENTRACARE CLINIC RIVER CAMPUS/BILLING
Mailing Address - Street 2:1200 6TH AVE N
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-2735
Mailing Address - Country:US
Mailing Address - Phone:203-240-2100
Mailing Address - Fax:320-240-2834
Practice Address - Street 1:1900 CENTRACARE CIR STE 2400
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-229-4916
Practice Address - Fax:320-229-5174
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4238133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered