Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Maxwell Dietmar Boenisch

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1326861360

Maxwell Dietmar Boenisch is a Student in an Organized Health Care Education/Training Program in Portland, Oregon. Registered with an NPI since 2024.

In the registry since
2024
Specialties on file
2
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Practice location Address checks out

4212 SE Division St
Portland, OR 97206-1680
Phone: (503) 238-0705
Fax: (503) 236-7166
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1326861360
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedNovember 7, 2024
Last updated in NPPESNovember 7, 2024
Certification dateNovember 7, 2024

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