Provider Demographics
NPI:1336230713
Name:GENERATIONS: COMMUNITY SUPPORT SERVICES
Entity type:Organization
Organization Name:GENERATIONS: COMMUNITY SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:GORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:612-676-1604
Mailing Address - Street 1:2649 PARK AVE S.
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55047
Mailing Address - Country:US
Mailing Address - Phone:612-676-1604
Mailing Address - Fax:612-379-8235
Practice Address - Street 1:60 MARIE AVE E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-5910
Practice Address - Country:US
Practice Address - Phone:651-552-9071
Practice Address - Fax:651-552-9874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1500106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1534157 00OtherMA - BEKAH SALITERMAN
MN4467043 00OtherMA - JAY THEISEN
MN5124786 00OtherMA - KARLA MUSSER
MN8273090 00OtherMA - JOHN LAMPERT
MN8279578 00OtherMA IN-HOME - GENERATIONS
MN9831134 00OtherMA CADI - GENERATIONS
MN4724372 00OtherMA - JORDAN HART
MN0025101 00OtherMA IN-OFFICE - GENERATION
MN1366084 00OtherMA - JENNIFER GERVAIS
MN0616371 00OtherMA - KATIE SHAW
MN7126875 00OtherMA - JOY PETERMANN
MN7194978 00OtherMA - KATHLEEN GORMAN
MN7676920 00OtherMA - VESSELA KOUNEVA
MN558915 00OtherMA - KIRSTEN JANKOVICH
MN8226083 00OtherMA - NICOLE HELLAND
MN5041406 00OtherMA - JO MCBRIDE