Yolanda M Jackson, CRM

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

22-CRM-1546 Issued in OR

Practice address

1817 NE 6TH Avenue
Portland, OR 97212-3906

Phone

(503) 719-7985

Fax

(503) 944-5262

NPI assigned

May 5, 2023

Sex

Female

Sole proprietor

Yes

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

Locations

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.

• Oregon Change Clinic, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Portland, OR
  • NPI 1881293215
  NPD

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

{
    "created_epoch": "1683244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683244800000",
    "number": "1487343380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1817 NE 6TH AVENUE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972123906",
            "telephone_number": "503-719-7985",
            "fax_number": "503-944-5262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1817 NE 6TH AVENUE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972123906",
            "telephone_number": "503-719-7985",
            "fax_number": "503-944-5262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "YOLANDA",
        "middle_name": "M",
        "credential": "CRM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-05-05",
        "last_updated": "2023-05-05",
        "certification_date": "2023-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "OR",
            "license": "22-CRM-1546",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven Jackson, MSW
• Steven Colin Jackson, MD
• Stuart Mark Jackson, LCSW
• Talia Jackson
• Vella L Jackson, DA
• Peter Jacky, PHD, FACMG
• Jacob M Bell, DC
• Benjamin Jacob
• David Jacob, LMT
• Tirzah D Jacob, LPC

• 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 May 5, 2023; 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.