Individual provider · Type 1 NPI

Nicole Jackson

Peer Specialist · Portland, OR

NPI number 1063390870 Active

Practice location

8355 N Interstate Ave
Portland, OR 97217-6716

Call (503) 568-1408 Map

Mailing address

7931 NE Halsey St Ste 307
Portland, OR 97213-6793

Specialties and licenses

TaxonomyCodeLicense
Community/Behavioral Health Agency 251S00000X25-QMHA-R-6774 (OR)
Peer Specialist Primary 175T00000X105324 (OR)
Addiction (Substance Use Disorder) Counselor 101YA0400XT-25-5762 (OR)

Peer Specialist: 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.

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About NPI 1063390870

Nicole Jackson's National Provider Identifier is 1063390870, issued on Aug 21, 2025. The primary taxonomy on file is Peer Specialist (175T00000X), and the practice location is in Portland, OR. The record was last updated on Oct 3, 2025.