Provider Demographics
NPI:1700429495
Name:STRIETZEL, MALY J (ND)
Entity Type:Individual
Prefix:
First Name:MALY
Middle Name:J
Last Name:STRIETZEL
Suffix:
Gender:F
Credentials:ND
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 55
Mailing Address - Street 2:
Mailing Address - City:THREE FORKS
Mailing Address - State:MT
Mailing Address - Zip Code:59752-0055
Mailing Address - Country:US
Mailing Address - Phone:970-946-8125
Mailing Address - Fax:
Practice Address - Street 1:962 STONERIDGE DR STE 2
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-7083
Practice Address - Country:US
Practice Address - Phone:406-586-2626
Practice Address - Fax:406-586-2676
Is Sole Proprietor?:No
Enumeration Date:2019-10-24
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTAHC-NAT-LIC-2339175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath