Provider Demographics
NPI:1013898980
Name:MANTICH, JODY A
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:A
Last Name:MANTICH
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 1:110 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:CRESCENT
Mailing Address - State:IA
Mailing Address - Zip Code:51526-4363
Mailing Address - Country:US
Mailing Address - Phone:855-493-1830
Mailing Address - Fax:
Practice Address - Street 1:8055 O ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2564
Practice Address - Country:US
Practice Address - Phone:402-421-1119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant