Provider Demographics
NPI:1801377122
Name:JERGER, MANDY (LPCC-S)
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:JERGER
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:JERGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPCC-S
Mailing Address - Street 1:22251 STATE ROUTE 2
Mailing Address - Street 2:
Mailing Address - City:ARCHBOLD
Mailing Address - State:OH
Mailing Address - Zip Code:43502-9452
Mailing Address - Country:US
Mailing Address - Phone:419-445-1552
Mailing Address - Fax:419-445-1401
Practice Address - Street 1:22251 STATE ROUTE 2
Practice Address - Street 2:
Practice Address - City:ARCHBOLD
Practice Address - State:OH
Practice Address - Zip Code:43502-9452
Practice Address - Country:US
Practice Address - Phone:419-445-1552
Practice Address - Fax:419-445-1401
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2404056251S00000X
OHE.2404056-SUPV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0312677Medicaid