Individual provider Active NPI

Mandy Lynn Lengerich, MSW

  • Clinical Social Worker
  • Fort Wayne, IN
National Provider Identifier
1376735084
Registry record updated May 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
34006139A Issued in IN
Practice address
10315 Dawsons Creek Blvd Ste E
Fort Wayne, IN 46825-1912
Phone
(260) 387-6340
NPI assigned
Aug 16, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 13, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X N/A IN
Clinical Social Worker 1041C0700X
Clinical Social Worker 1041C0700X 34006139A IN Primary

Addresses

Primary practice location

10315 Dawsons Creek Blvd Ste E
Fort Wayne, IN 46825-1912

Mailing address

10315 Dawsons Creek Blvd Ste E
Fort Wayne, IN 46825-1912
Phone (260) 387-6340

Other names 1

  • Miss Mandy Lynn Krueckeberg Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250709000867 IN Practitioner - Clinical Social Worker 1951815208 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

10315 Dawsons Creek Blvd
Suite E
Fort Wayne, IN 46825-1912
Phone 2603876340111

10315 Dawsons Creek Blvd E
Fort Wayne, IN 46825-1912

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
N/AINMDSocial Worker
34006139AINMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Life Rhythms Counseling Clinical CurrentSince May 5, 2025 Accepting new patients

Locations

10315 Dawsons Creek Blvd
Ste E
Fort Wayne, IN 46825
Phone (260) 387-3640

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1187222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747094400000",
    "number": "1376735084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10315 DAWSONS CREEK BLVD STE E",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251912",
            "telephone_number": "260-387-6340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10315 DAWSONS CREEK BLVD STE E",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251912",
            "telephone_number": "260-387-6340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LENGERICH",
        "first_name": "MANDY",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "MSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-08-16",
        "last_updated": "2025-05-13",
        "certification_date": "2025-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IN",
            "license": "N/A",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34006139A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MANDY",
            "last_name": "KRUECKEBERG",
            "middle_name": "LYNN",
            "prefix": "MISS",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.