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

Nathan Jaylen Nickerson

Individual provider Counselor · NPI 1104504869

Nathan Jaylen Nickerson is a Counselor in Portland, Oregon. Registered with an NPI since 2023.

In the registry since
2023

Practice location Address checks out

3415 SE Powell Blvd
Portland, OR 97202-3371
Phone: (503) 234-9591
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Counselor (primary) Taxonomy 101Y00000X

Record details

NPI number1104504869
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJuly 11, 2023
Last updated in NPPESFebruary 3, 2026
Certification dateFebruary 3, 2026

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