Otterstrom, Jack Lee

Otterstrom, Jack Lee is an sole proprietor health care provider with primary practice located at 656 Jasmine Cir , Independence OR 97351-9578. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Professional, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Otterstrom, Jack Lee can be contacted via phone (541) 231-8023.

Contact Information

Primary practice address
656 Jasmine Cir Independence OR 97351-9578
Phone: (541) 231-8023
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X L5316 Oregon
Behavioral Health & Social Service Providers / Clinical 1041C0700X L3516 Oregon
Behavioral Health & Social Service Providers / Clinical 1041C0700X Oregon

Profile Details

NPI number 1922163096
LBN Legal business name Otterstrom, Jack Lee
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 27th, 2006
Last updated Sep 6th, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1922163096 NPPES
Oregon MEDICAID R145387

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