Provider Demographics
NPI:1134957202
Name:MATTES, BRYN
Entity type:Individual
Prefix:
First Name:BRYN
Middle Name:
Last Name:MATTES
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 1:913 SHEIDLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BONNER SPRINGS
Mailing Address - State:KS
Mailing Address - Zip Code:66012-9514
Mailing Address - Country:US
Mailing Address - Phone:816-204-0867
Mailing Address - Fax:816-439-8018
Practice Address - Street 1:1009 SE BROWNING AVE
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-2922
Practice Address - Country:US
Practice Address - Phone:816-301-4533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician