Healthcare Provider Details

I. General information

NPI: 1063393296
Provider Name (Legal Business Name): ERICA RENEE KEGLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 WOODLAWN AVE
NORWALK OH
44857-2236
US

IV. Provider business mailing address

85 RENFREW DR
SHELBY OH
44875-1821
US

V. Phone/Fax

Practice location:
  • Phone: 567-560-3587
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: