Healthcare Provider Details

I. General information

NPI: 1225195936
Provider Name (Legal Business Name): TONYA RAE GOTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 TECHNOLOGY DR
DULUTH MN
55811-4115
US

IV. Provider business mailing address

5041 S BAY RD
DULUTH MN
55803-8404
US

V. Phone/Fax

Practice location:
  • Phone: 218-728-9556
  • Fax:
Mailing address:
  • Phone: 218-969-2270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7110
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: