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LAURIE JACKSON CADC
NPI 1124668447
Counselor - Addiction (Substance Use Disorder) in Portland, OR

Active since January 14, 2020
1122 NE 122ND AVE STE A102, PORTLAND, OR 97230(855) 237-9882 Get Directions Write a Review

NPPES record last updated: December 29, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Dec 29, 2021, Jan 14, 2020 (2 updates tracked since 2020).

About Laurie Jackson Cadc NPPES

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

LAURIE JACKSON CADC (NPI 1124668447) is an individual addiction (substance use disorder) provider in Portland, Oregon and active in the NPI registry since January 2020. She maintains a secondary practice location in Portland.

NPPES Registry Identity

NPI1124668447
Entity TypeIndividualFemale
Primary Taxonomy101YA0400X
Provider Legal NameLAURIE JACKSONCredential: CADC
Location Address1122 NE 122ND AVE STE A102Portland, OR 97230-2082
Mailing Address11400 Se 90th Ave Apt 1424Happy Valley, OR 97086-2626 · (503) 607-5791
Phone(855) 237-9882
Sole ProprietorNo
Enumeration DateJanuary 14, 2020
Last NPPES UpdateDecember 29, 20212 updates tracked since enumeration
NPPES CertifiedDecember 29, 2021
✔ NPI 1124668447 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Addiction (Substance Use Disorder)Behavioral Health & Social Service Providers
Taxonomy Code101YA0400X
1122 NE 122ND AVE STE A102, Portland, OR 97230
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Other Names 1

Other Name (5)Tina Fortin Cadc

Secondary Practice Location 1

Location 1232 NW 6th AvePortland, OR 97209-3609 · Phone (503) 294-1681

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

IAN STUART MURPHY
Student in an Organized Health Care Education/Training Program
1122 NE 122ND AVE STE A102
PORTLAND, OR 97230
Multnomah County (503) 389-6536
LAURA FAYE DUNN RN CADC1
Counselor (Addiction (Substance Use Disorder))
1122 NE 122ND AVE STE A102
PORTLAND, OR 97230
Multnomah County (503) 901-4203
JULIA ROSE EGGEN CRM
Counselor (Addiction (Substance Use Disorder))
1122 NE 122ND AVE STE A102
PORTLAND, OR 97230
Multnomah County (855) 237-9882

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 Laurie Jackson's NPI number?

The NPI number for Laurie Jackson is 1124668447. It was assigned to this individual provider in the NPPES registry on January 14, 2020. The provider is also known as Tina Fortin Cadc.

Where is Laurie Jackson located?

Laurie Jackson practices at 1122 NE 122nd Ave Ste A102, Portland, OR 97230. The listed phone number is (855) 237-9882.

What is Laurie Jackson's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Addiction (Substance Use Disorder), with taxonomy code 101YA0400X.

When was this NPI record last updated?

The NPPES record for Laurie Jackson was last updated on December 29, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years 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.