Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1922163096 Individual Practitioner Male Practitioner

Jack Lee Otterstrom , LCSW

Social Worker - Clinical • Independence, OR

Professional Overview & Biography Verified Profile Summary

Jack Otterstrom, LCSW is a registered healthcare professional specializing in Social Worker - Clinical in Independence, OR. Practice services are available at 656 JASMINE CIR under active NPI credentials.

Frequently performed procedures and clinical services include psychotherapy, health and behavior intervention, individual each. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

656 Jasmine Cir

Independence, OR 973519578

Telephone 5412318023

Specialty Benchmarks & Practice Insights

Comparative analytics for Social Worker - Clinical in Independence, OR

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 17.9 Yrs
Regional Practice Density
1 Specialists

Practicing in Independence, OR (5148 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
69.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2020)
Reporting Year:
HCPCS Code & Description Services Patients Submitted Charge Medicare Allowed
90832 Psychotherapy, 30 minutes
35 14 $170.57 $52.12

Medical Specialties & State Licenses

CMS Verified: 2022-09-06
Social Worker - Clinical Primary Specialty

NUCC Taxonomy Code: 1041C0700X

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.

Counselor - Professional

NUCC Taxonomy Code: 101YP2500X

State License OR L5316

Definition to come...

Social Worker - Clinical

NUCC Taxonomy Code: 1041C0700X

State License OR L3516

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.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
R145387 (OR)

Secondary Practice Locations

250 W Marquam St

Mount Angel, OR 973629520

Phone: 9719835214

Career & Practice History Timeline

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

13 Historical Events
📍
Updated Practice Location September 06, 2022

Registered at 656 JASMINE CIR, INDEPENDENCE, OR 973519578 (Tel: 5412318023)

📍
Updated Business Mailing Address September 06, 2022

Registered at 619 BROAD ST S # 19, MONMOUTH, OR 973612372 (Tel: 4123180235)

NPI Profile Active May 18, 2017

NPI status registered as active in NPPES database

📍
Updated Practice Location May 18, 2017

Registered at 250 W MARQUAM ST, MOUNT ANGEL, OR 973629520 (Tel: 9719835214)

📍
Updated Business Mailing Address May 18, 2017

Registered at PO BOX 278, WOODBURN, OR 970710278 (Tel: 9719835260)

👤
Provider Name / Credentials Updated May 18, 2017

Recorded as JACK OTTERSTROM, LCSW

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) May 18, 2017

Counselor (License #L5316 in OR)

NPI Profile Active August 31, 2015

NPI status registered as active in NPPES database

📍
Updated Practice Location August 31, 2015

Registered at 250 W MARQUAM ST, MT. ANGEL, OR 97362 (Tel: 9719835214)

📍
Updated Business Mailing Address August 31, 2015

Registered at 1475 MT. HOOD AVE, WOODBURN, OR 97071 (Tel: 9719835333)

👤
Provider Name / Credentials Updated August 31, 2015

Recorded as JACK OTTERSTROM, LCSW

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) August 31, 2015

Counselor (License #L5316 in OR)

🟢
Initial NPI Registration & Enumeration December 27, 2006

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: 1922163096
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: December 27, 2006
Last Update: September 06, 2022
Sole Proprietor: Yes

Mailing Address

619 Broad St S # 19

Monmouth, OR 973612372

Phone: 4123180235

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.