Gracelyn N Nickerson, PSS

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

113974 Issued in OR

Practice address

547 SW 7TH St
Newport, OR 97365-4909

Phone

(541) 574-9570

Fax

(541) 574-8857

NPI assigned

May 13, 2025

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Reconnections a and D

  • Addiction (Substance Use Disorder) Counselor
  • Newport, OR
  • NPI 1588692040
  NPD (past)

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

{
    "created_epoch": "1747094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747094400000",
    "number": "1245021971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1538",
            "city": "NEWPORT",
            "state": "OR",
            "postal_code": "973650115",
            "telephone_number": "541-574-9570",
            "fax_number": "541-574-8857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "547 SW 7TH ST",
            "city": "NEWPORT",
            "state": "OR",
            "postal_code": "973654909",
            "telephone_number": "541-574-9570",
            "fax_number": "541-574-8857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKERSON",
        "first_name": "GRACELYN",
        "middle_name": "N",
        "credential": "PSS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-05-13",
        "last_updated": "2025-05-13",
        "certification_date": "2025-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "OR",
            "license": "113974",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Newport Rehabilitation, Inc.
• Newport Rehabilitation, LLC
• Newport Rental Services Inc.
• Yen B. Nguyen, D.O.
• Mary-Beth Nickel, L.P.C, M.A., D.V.M.
• Norco, Inc.
• Norman Todd Gale LLC
• Northwest Coastal Housing
• Vicki B. Norton, CADCI
• Oc Eyecare LLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 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.