Erica Susanna Jackson, SUDP/T

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CO61691434 Issued in WA

Practice address

1505 Kla-Ook Wa Drive
Taholah, WA 98587

Phone

(360) 276-8211

NPI assigned

Feb 5, 2026

Last updated

Feb 5, 2026By the provider in NPPES

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

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

{
    "created_epoch": "1770249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770249600000",
    "number": "1558212605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 608",
            "city": "AMANDA PARK",
            "state": "WA",
            "postal_code": "985260608",
            "telephone_number": "360-276-8211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 KLA-OOK WA DRIVE",
            "city": "TAHOLAH",
            "state": "WA",
            "postal_code": "98587",
            "telephone_number": "360-276-8211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ERICA",
        "middle_name": "SUSANNA",
        "credential": "SUDP/T",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-02-05",
        "last_updated": "2026-02-05",
        "certification_date": "2026-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CO61691434",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gary D Faber
• Alex Eugene Fabini, MA, LPC
• David A Hagen, CHEMICAL DEPENDENCY
• Lisa Hall
• Mary Louise Hart, ARNP
• Mishelle Jackson, SUDPT
• Michelle Elizabeth Kloppman, PHARMACIST
• Gregory G Kozlowski, DDS
• Robert J Lagerquist, CHEMICAL DEPENDENCY
• Kimberly Claire McLaury, R.D.

• Addiction (Substance Use Disorder) Counselor in Taholah, WA
• Providers in Taholah, WA by specialty
• Addiction (Substance Use Disorder) Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2026; 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.