Healthcare Provider Details

I. General information

NPI: 1801377122
Provider Name (Legal Business Name): AMANDA JERGER LPCC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MANDY JERGER LPCC-S

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 RALSTON AVE
DEFIANCE OH
43512-5312
US

IV. Provider business mailing address

329 N WEST ST
LIMA OH
45801-4332
US

V. Phone/Fax

Practice location:
  • Phone: 419-567-2138
  • Fax: 419-225-8878
Mailing address:
  • Phone: 419-221-3072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2404056-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: