MR. JACK LEE OTTERSTROM LCSW
NPI 1922163096
Social Worker - Clinical in Independence, OR
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 and maintains a secondary practice location in Mount Angel.
NPPES Registry Identity
Specialties & Licenses 2
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.
Other Names 1
Secondary Practice Location 1
Other Identifiers 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
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.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1922163096, enumerated as an "individual" on December 27, 2006.
The provider is located at 656 JASMINE CIR INDEPENDENCE, OR 97351 and the phone number is (541) 231-8023.
Social Worker with taxonomy code 1041C0700X and a focus in Clinical.
The provider might be accepting Accepts: Blue Cross and Blue Shield of Texas, BridgeSpan. Please consult your insurance carrier or call the provider to verify.
