Provider Demographics
NPI:1841001633
Name:KER, BENJAMIN KANYIMBE
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:KANYIMBE
Last Name:KER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:KANYIMBE
Other - Middle Name:
Other - Last Name:KER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:10572 SE WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2809
Mailing Address - Country:US
Mailing Address - Phone:503-284-6883
Mailing Address - Fax:
Practice Address - Street 1:10572 SE WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2809
Practice Address - Country:US
Practice Address - Phone:503-284-6883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling