Provider Demographics
NPI:1205403094
Name:MATZ, JODI (RD, NBC-HWC)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:MATZ
Suffix:
Gender:F
Credentials:RD, NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15710 W 135TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1508
Mailing Address - Country:US
Mailing Address - Phone:913-297-7472
Mailing Address - Fax:
Practice Address - Street 1:15710 W 135TH ST STE 200
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1508
Practice Address - Country:US
Practice Address - Phone:816-395-3128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1037133V00000X
MO2016009164133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered