Laurie Jackson, CADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

1122 NE 122ND Ave Ste A102
Portland, OR 97230-2082

Phone

(855) 237-9882

NPI assigned

Jan 14, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Tina Fortin Other name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sober Living Oregon Recovery Center

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Oregon City, OR
  • NPI 1073081881
  NPD (past)

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

{
    "created_epoch": "1578960000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640736000000",
    "number": "1124668447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11400 SE 90TH AVE APT 1424",
            "city": "HAPPY VALLEY",
            "state": "OR",
            "postal_code": "970862626",
            "telephone_number": "503-607-5791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1122 NE 122ND AVE STE A102",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972302082",
            "telephone_number": "855-237-9882"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "232 NW 6th Ave",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972093609",
            "country_code": "US",
            "telephone_number": "503-294-1681",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "LAURIE",
        "credential": "CADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-14",
        "last_updated": "2021-12-29",
        "certification_date": "2021-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Portland",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Portland",
            "address_1": "1122 NE 122nd Ave Ste A102",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972302082",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "TINA",
            "last_name": "FORTIN",
            "credential": "CADC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Judy Jackson
• Julie D Jackson, CADC
• Kimberly L Jackson
• Lashaunda Louise Jackson
• Laura Marie Jackson, FNP, CWCN
• Lloyd Chris Jackson, MCM, CADC I, CRM II
• Lydia Michelle Jackson
• Mallori A Jackson
• Melinda Ann Jackson
• Melissa T Jackson, MS HUMAN SERVICES

• Addiction (Substance Use Disorder) Counselor in Portland, OR
• Providers in Portland, OR by specialty
• Addiction (Substance Use Disorder) Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2021; 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.