MR. JACK LEE OTTERSTROM (LCSW) – Clinical Social Worker, NPI 1922163096

Clinical Social Worker

MR. JACK LEE OTTERSTROM (LCSW) is a healthcare provider. based in Woodburn, Oregon. specializing in Clinical Social Worker. They hold the professional credentials LCSW. They hold a License No. L5316 (OR). The NPI Number for MR. JACK LEE OTTERSTROM (LCSW) is 1922163096

Main info

Male

Sole Proprietor

25 Years Of Experience

Accepts Medicare Assignment

Name

MR. JACK LEE OTTERSTROM (LCSW)

NPI

1922163096

Phone

(971) 983-5260

Address

PO BOX 278

Enumeration Date

27 December 2006

Last Update Date

6 September 2022

Doctor Profile

Medical School Name

OTHER

Secondary Phone

5038735667

Graduation Year

2001 (25 years ago)

PAC ID

5991801052

Group Practice PAC ID

8921901877

Professional Enrollment ID

I20070507000154

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience71

Completeness75

Years active:19State licenses:2Digital endpointsOther names

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Provider Addresses for MR. JACK LEE OTTERSTROM (LCSW)

PO BOX 278
WOODBURN, OR 970710278
Phone: (971) 983-5260
Type: Mailing
250, West Marquam Street, Mount Angel, Marion County, Oregon, 97373, United States
MOUNT ANGEL, OR 973629520
Phone: (971) 983-5214
Fax: (971) 983-5219
Type: Location
619 BROAD ST S # 19
MONMOUTH, OR 973612372
Phone: (412) 318-0235
Type: Mailing
656 JASMINE CIR
INDEPENDENCE, OR 973519578
Phone: (541) 231-8023
Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 97071)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 8921901877View full group profile

Name	Specialty	State
STEPHANIE NICKSON (MSW, LCSW)	-	OR
DR. MARIE HEBERT (M.D.)	Family Practice	OR
MARTIN ROBERT BOX (MD)	Family Practice	WA
ALFONSO CAPURAS (APRN)	Nurse Practitioner	TX
DR. JULIE CHRISTINE BROYHILL (MD)	Family Practice	OR
MR. ANTHONY NELSON SMITH (P.A.)	-	OR
DR. SEAN GLASS (MD)	P S Y C H I A T R Y	MA
GILBERT EARL NICHOLSON-NELSON (M.S.W., L.C.S.W.)	Clinical Social Worker	OR
MR. STEPHEN JOSEPH COMELLA (LPC)	Mental Health Counselor	OR
JAMEY LYNN WALKER (M.D.)	Family Practice	OR

Reviews

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Frequently asked questions

Can I use this page to confirm MR. JACK LEE OTTERSTROM (LCSW)'s NPI?

Yes. MR. JACK LEE OTTERSTROM (LCSW) is listed with NPI 1922163096 in the public NPI dataset.

Is MR. JACK LEE OTTERSTROM (LCSW) listed as active for patients and plans?

The listing shows MR. JACK LEE OTTERSTROM (LCSW) as active in the NPI system.

What taxonomy line describes MR. JACK LEE OTTERSTROM (LCSW)?

For research purposes, treat MR. JACK LEE OTTERSTROM (LCSW) as Clinical Social Worker in this dataset. Clinical services aligned with this taxonomy classification.

What address line appears for MR. JACK LEE OTTERSTROM (LCSW)?

MR. JACK LEE OTTERSTROM (LCSW)'s geographic hint is Woodburn, Oregon in our summary view.

How many locations tie to this NPI?

4 practice locations appear in the available data.