It begins at Klickitat Lake, fed by Klickitat and Lake creeks in the Central Oregon Coast Range, and flows generally south to near Alsea, where it joins the South Fork Alsea River to form the main stem.

[4] The Alsea Hatchery, constructed by the state in 1936, raises winter steelhead and other rainbow trout along the North Fork.

[5] According to Fishing in Oregon, the river is a "beautiful stream (well-suited to fly angling) with a large run of hatchery winter steelhead.

Amenities include picnic tables, restrooms, a self-guided nature trail, fishing and "areas for water play".

[7] Listed from source to mouth, the named tributaries begin with Klickitat and Lake creeks, which form Klickitat Lake, the headwaters of the North Fork Alsea River.