Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
NICOLE JACKSON
ActiveNICOLE JACKSON is a Peer Specialist healthcare provider located in PORTLAND, Oregon. NPI 1063390870 is currently active in the NPPES registry. Verify at CMS.
Peer Specialist · PORTLAND, OR
Registration Details
- NPI Number
- 1063390870
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- Aug 21, 2025 (1.0208817319806 yrs)
- Last Updated
- Oct 3, 2025
- Licenses
-
25-QMHA-R-6774 (OR)105324 (OR)T-25-5762 (OR)
Practice Information
- Address
-
8355 N INTERSTATE AVEPORTLAND, OR, 972176716Browse OR providers · Browse ZIP 97217
- Phone
- 5035681408
- Primary Specialty
-
Peer Specialist
175T00000X
- Additional Specialty
- Peer Specialist
- Additional Specialty
- Addiction (Substance Use Disorder) Counselor
Other Peer Specialist Providers in PORTLAND, OR
| Name | Credential | NPI |
|---|---|---|
| GARY D WARNOCK | CADC I | 1740484286 |
| KERI MCNICHOLAS | — | 1235322686 |
| MRS. DEBRA LYNN RUSSELL | — | 1760658462 |
| JIM V WHIPPLE | — | 1598095713 |
| SHERYL COOKSLEY | — | 1407145626 |
| KRATER H BUELL | PSS | 1538426978 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.