Provider Demographics
NPI:1821894544
Name:BENNIGHT, SPENCER
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:
Last Name:BENNIGHT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 SE LAKE RD STE 175
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97222-2137
Mailing Address - Country:US
Mailing Address - Phone:628-587-7237
Mailing Address - Fax:
Practice Address - Street 1:6400 SE LAKE RD STE 175
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97222-2137
Practice Address - Country:US
Practice Address - Phone:628-587-7237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-22
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician