Provider Demographics
NPI:1659447175
Name:GOETZ, DEBBIE ANN
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:ANN
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 1:3800 SW CEDAR HILLS BLVD
Mailing Address - Street 2:203
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2027
Mailing Address - Country:US
Mailing Address - Phone:503-680-4612
Mailing Address - Fax:
Practice Address - Street 1:3800 SW CEDAR HILLS BLVD
Practice Address - Street 2:203
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2027
Practice Address - Country:US
Practice Address - Phone:503-680-4612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11405174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist