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

Nicole Jackson

Individual provider Community/Behavioral Health Agency · NPI 1063390870

Nicole Jackson is a Community/Behavioral Health Agency in Portland, Oregon. Licensed in Oregon. Registered with an NPI since 2025.

Licensed in
OR
In the registry since
2025
Specialties on file
3

Practice location Address checks out

8355 N Interstate Ave
Portland, OR 97217-6716
Phone: (503) 568-1408
Show map & directions

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

Specialties & licences

Peer Specialist (primary) Taxonomy 175T00000X · Licence 105324 (OR)
Community/Behavioral Health Agency Taxonomy 251S00000X · Licence 25-QMHA-R-6774 (OR)
Addiction (Substance Use Disorder) Counselor Taxonomy 101YA0400X · Licence T-25-5762 (OR)

Record details

NPI number1063390870
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedAugust 21, 2025
Last updated in NPPESOctober 3, 2025
Certification dateOctober 3, 2025

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