Individual provider · Type 1 NPI
Jack Lee Otterstrom, LCSW
Clinical Social Worker · Independence, OR
Practice location
656 Jasmine Cir
Independence, OR 97351-9578
Mailing address
619 Broad St S # 19
Monmouth, OR 97361-2372
Other practice locations
- 250 W Marquam St, Mount Angel, OR 97362-9520 · (971) 983-5214
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Professional Counselor | 101YP2500X | L5316 (OR) |
| Clinical Social Worker | 1041C0700X | L3516 (OR) |
| Clinical Social Worker Primary | 1041C0700X | None listed |
Clinical Social Worker: 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 interpers…
About NPI 1922163096
Jack Lee Otterstrom, LCSW's National Provider Identifier is 1922163096, issued on Dec 27, 2006. The primary taxonomy on file is Clinical Social Worker (1041C0700X), and the practice location is in Independence, OR. The record was last updated on Sep 6, 2022.