Individual
ELLEN BENNINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
QMHA
Contact information
Practice address
847 NE 19TH AVE STE 100, PORTLAND, OR 97232-2684
(032) 380-7695
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
(503) 234-9591
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
OR
Other
Enumeration date
09/01/2016
Last updated
07/23/2019
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