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MR. JACK LEE OTTERSTROM LCSW
NPI 1922163096
Social Worker - Clinical in Independence, OR

Active since December 27, 2006Opted out of Medicare · through Jan 1, 2028
656 JASMINE CIR, INDEPENDENCE, OR 97351(541) 231-8023 Get Directions Write a Review

NPPES record last updated: September 6, 2022. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Sep 6, 2022, May 18, 2017 (2 updates tracked since 2017).

About Mr. Jack Lee Otterstrom Lcsw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. JACK LEE OTTERSTROM LCSW (NPI 1922163096) is an individual clinical provider in Independence, Oregon, licensed in Oregon (L3516) and active in the NPI registry since December 2006. He has opted out of Medicare through January 1, 2028.

NPPES Registry Identity

NPI1922163096
Entity TypeIndividualMale
Primary Taxonomy1041C0700X
Provider Legal NameMR. JACK LEE OTTERSTROMCredential: LCSW
Location Address656 JASMINE CIRIndependence, OR 97351-9578
Mailing Address619 Broad St S # 19Monmouth, OR 97361-2372 · (412) 318-0235
Phone(541) 231-8023
Sole ProprietorYes
Enumeration DateDecember 27, 2006
Last NPPES UpdateSeptember 6, 20222 updates tracked since enumeration
NPPES CertifiedSeptember 6, 2022
✔ NPI 1922163096 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
License✔ Licensed in OR · L3516
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
Also ListedCounselor · ProfessionalTaxonomy 101YP2500X · License L5316 (OR)
656 JASMINE CIR, Independence, OR 97351
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Other Names 1

Other Name (5)Mr. Jay Lee Otterstrom Lscw

Other Identifiers 1

MedicaidR145387OR

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Texas, BridgeSpan Health Company, PacificSource Health Plans and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

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Opted out of Medicare

Mr. Jack Lee Otterstrom Lcsw has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from January 1, 2026 through January 1, 2028.

Opt-Out Effective DateJanuary 1, 2026
Opt-Out In Effect ThroughJanuary 1, 2028Opt-out affidavits renew automatically every two years unless cancelled

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jack Otterstrom's NPI number?

The NPI number for Jack Otterstrom is 1922163096. It was assigned to this individual provider in the NPPES registry on December 27, 2006. The provider is also known as Mr. Jay Lee Otterstrom Lscw.

Where is Jack Otterstrom located?

Jack Otterstrom practices at 656 Jasmine Cir, Independence, OR 97351. The listed phone number is (541) 231-8023.

What is Jack Otterstrom's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Jack Otterstrom enrolled in Medicare?

No. Jack Otterstrom has opted out of Medicare through January 1, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

What insurance does Jack Otterstrom accept?

Health plans from Blue Cross and Blue Shield of Texas, BridgeSpan Health Company, PacificSource Health Plans and Regence BlueCross BlueShield of Oregon list Jack Otterstrom as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Jack Otterstrom was last updated on September 6, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.