Individual
BENJAMIN BROENEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5019 NE 102ND AVE UNIT A, PORTLAND, OR 97220-1199
(971) 383-1220
Mailing address
232 NW 6TH AVE, PORTLAND, OR 97209-3609
(503) 294-1681
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
23-CRM-2237
OR
Other
Enumeration date
08/02/2023
Last updated
08/02/2023
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