Healthcare Provider Details

I. General information

NPI: 1104744812
Provider Name (Legal Business Name): JENNIFER ERACLES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3918 CLOCK POINTE TRL STE 103
STOW OH
44224-2989
US

IV. Provider business mailing address

925 HERON SPRINGS PKWY
STOW OH
44224-2953
US

V. Phone/Fax

Practice location:
  • Phone: 216-839-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2608122
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: