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NICOLE JACKSON
NPI 1063390870
Peer Specialist in Portland, OR

Active since August 21, 2025
8355 N INTERSTATE AVE, PORTLAND, OR 97217(503) 568-1408 Get Directions Write a Review

NPPES record last updated: October 3, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Nicole Jackson NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NICOLE JACKSON (NPI 1063390870) is an individual peer specialist in Portland, Oregon, licensed in Oregon (105324) and active in the NPI registry since August 2025.

NPPES Registry Identity

NPI1063390870
Entity TypeIndividualFemale
Primary Taxonomy175T00000X
Provider Legal NameNICOLE JACKSON
Location Address8355 N INTERSTATE AVEPortland, OR 97217-6716
Mailing Address7931 Ne Halsey St Ste 307Portland, OR 97213-6793 · (208) 899-2604
Phone(503) 568-1408
Sole ProprietorNo
Enumeration DateAugust 21, 2025
Last NPPES UpdateOctober 3, 2025
NPPES CertifiedOctober 3, 2025
✔ NPI 1063390870 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPeer SpecialistOther Service Providers
Taxonomy Code175T00000X
License✔ Licensed in OR · 105324
Definition
Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X · License T-25-5762 (OR)
Also ListedCommunity/Behavioral HealthTaxonomy 251S00000X · License 25-QMHA-R-6774 (OR)
8355 N INTERSTATE AVE, Portland, OR 97217
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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Nicole Jackson's NPI number?

The NPI number for Nicole Jackson is 1063390870. It was assigned to this individual provider in the NPPES registry on August 21, 2025.

Where is Nicole Jackson located?

Nicole Jackson practices at 8355 N Interstate Ave, Portland, OR 97217. The listed phone number is (503) 568-1408.

What is Nicole Jackson's specialty?

The primary specialty registered for this NPI is Peer Specialist with taxonomy code 175T00000X.

When was this NPI record last updated?

The NPPES record for Nicole Jackson was last updated on October 3, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.