Healthcare Provider Details

I. General information

NPI: 1609520204
Provider Name (Legal Business Name): OUR GENERATIONS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2022
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 W. BROADWAY STE 104
MONONA WI
53713-1603
US

IV. Provider business mailing address

1955 W. BROADWAY STE 104
MONONA WI
53713-1603
US

V. Phone/Fax

Practice location:
  • Phone: 608-405-3002
  • Fax: 608-405-5107
Mailing address:
  • Phone: 608-405-3002
  • Fax: 608-405-5107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: RUCHITA ERVIN
Title or Position: OWNER/CEO
Credential: L.P.C.
Phone: 608-201-6964