MEDICARE: MR. BENJAMIN NOAH WHITE M.ED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1538041413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BENJAMIN NOAH WHITE M.ED

Provider Business Mailing Address
First Line	:	1103 NE 177TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97230-6319
Country	:	US
Telephone Number	:	971-240-7771
Fax Number	:

Provider Business Practice Location Address
First Line	:	1103 NE 177TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97230-6319
Country	:	US
Telephone Number	:	971-240-7771
Fax Number	:	971-229-4072

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2025
Last Update Date	:	07/22/2025

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