Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1669399903 Individual Practitioner Male Practitioner

Jacob O Johnson

Counselor - Addiction (Substance Use Disorder) • Gresham, OR

Professional Overview & Biography Verified Profile Summary

Jacob Johnson is a registered healthcare professional specializing in Counselor - Addiction (Substance Use Disorder) in Gresham, OR. Practice services are available at 1217 NE BURNSIDE RD STE 701 under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

1217 Ne Burnside Rd Ste 701

Gresham, OR 970305770

Telephone 5037401971
Fax 5037712436
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Counselor - Addiction (Substance Use Disorder) in Gresham, OR

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 11.1 Yrs
Regional Practice Density
83 Specialists

Practicing in Gresham, OR (4216 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2026-06-29
Counselor - Addiction (Substance Use Disorder) Primary Specialty

NUCC Taxonomy Code: 101YA0400X

State License OR T-25-5918

Definition to come...

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

25 Associated Practitioners
Karissa Mathews , CRM

Peer Specialist

NPI 1013874866
Bethanie Wilson , CRM

Peer Specialist

NPI 1104708015
Michelle Krummenacker , LCSW

Social Worker - Clinical

NPI 1124033618

Licensed Clinical Social Worker

Britt Ricci , LCSW

Social Worker - Clinical

NPI 1154561462

Licensed Clinical Social Worker

Pamela Cline , LCSW

Social Worker - Clinical

NPI 1336282979

Licensed Clinical Social Worker

NPI 1356776447

Doctor of Psychology (Psy.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events
NPI Profile Active June 29, 2026

NPI status registered as active in NPPES database

📍
Updated Practice Location June 29, 2026

Registered at 1217 NE BURNSIDE RD STE 701, GRESHAM, OR 970305770 (Tel: 5037401971)

📍
Updated Business Mailing Address June 29, 2026

Registered at 17893 SW NELS DR, SHERWOOD, OR 971408079 (Tel: 5033329041)

👤
Provider Name / Credentials Updated June 29, 2026

Recorded as JACOB JOHNSON

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) June 29, 2026

Counselor (License #T-25-5918 in OR)

🟢
Initial NPI Registration & Enumeration June 29, 2026

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1669399903
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: June 29, 2026
Last Update: June 29, 2026
Sole Proprietor: Yes

Mailing Address

17893 Sw Nels Dr

Sherwood, OR 971408079

Phone: 5033329041

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.