Nicole Jackson

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

105324 Issued in OR

Practice address

8355 N Interstate Ave
Portland, OR 97217-6716

Phone

(503) 568-1408

NPI assigned

Aug 21, 2025

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1755734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759449600000",
    "number": "1063390870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7931 NE HALSEY ST STE 307",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972136793",
            "telephone_number": "208-899-2604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8355 N INTERSTATE AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972176716",
            "telephone_number": "503-568-1408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-08-21",
        "last_updated": "2025-10-03",
        "certification_date": "2025-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "OR",
            "license": "25-QMHA-R-6774",
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "OR",
            "license": "105324",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "T-25-5762",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melinda Ann Jackson
• Melissa T Jackson, MS HUMAN SERVICES
• Michelle Jackson, M.S., OTR/L
• Natalie Jo Jackson
• Natasha Marie Jackson
• Patricia Louise Jackson, RN
• Peter Jackson, M.D.
• Rachael Alexis Jackson, MS, MSW, LCSW
• Rachel K Jackson, MD
• Rachel M. Jackson, BEHAVIOR ANALYST

• Peer Specialist in Portland, OR
• Providers in Portland, OR by specialty
• Peer Specialist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.