Individual
TYLER BENNINK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
413 GATEWAY AVE, ASTORIA, OR 97103-6032
(503) 325-5722
Mailing address
65 N HIGHWAY 101 STE 204, WARRENTON, OR 97146-9371
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
172V00000X
Community Health Worker
—
—
Other
Enumeration date
08/17/2020
Last updated
05/06/2025
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