Jack Lee Otterstrom in Independence - Clinical
Jack Lee Otterstrom - NPI 1922163096
Jack Lee Otterstrom is a Clinical in Independence, Oregon. Jack Lee Otterstrom practices all healthcare services and medical treatments related to Clinical. The NPI Number for Jack Lee Otterstrom is 1922163096. The last update date is 2022-09-06.
Jack Lee Otterstrom's current location address is 656 Jasmine Cir, Independence, Oregon. You can contact this provider via phone number 5412318023. The mailing address for Jack Lee Otterstrom is 656 Jasmine Cir, Independence, Oregon. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Jack Lee Otterstrom |
|---|---|
| Address | 656 Jasmine Cir, Independence, Oregon |
| Phone Number | 5412318023 |
| Fax Number | |
| Sole Proprietor | Y |
| Credentials | LCSW |
NPI Number Detail
| NPI Number | 1922163096 |
|---|---|
| Provider Enumeration Date | 2006-12-27 |
| Last Updated Date | 2022-09-06 |
Provider Mailing Address Detail
| Address | 656 Jasmine Cir |
|---|---|
| City | Independence |
| State | Oregon (OR) |
| Post Code | 973519578 |
| Phone Number | 5412318023 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Clinical |
|---|---|
| Taxonomy | 1041C0700X |
| Licence No | L3516 |
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Definition: 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, certif |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| R145387 | OR | -- |
Post Comment/ Review Below
What is the unique identifier code issued to Jack Lee Otterstrom by the Centers for Medicare & Medicaid Services (CMS)?
The Jack Lee Otterstrom has been assigned the NPI (National Provider Identifier) 1922163096. This 10-digit code serves as a unique identification number for healthcare providers, issued by the CMS.
Could you please provide the complete street address where Jack Lee Otterstrom is physically located?
The Jack Lee Otterstrom is physically situated at the following address: 656 Jasmine Cir, Independence, OR, 973519578.
What is Jack Lee Otterstrom's primary field of medical specialization, and what is the corresponding taxonomy classification code for this area of expertise?
The primary field of medical specialization for Jack Lee Otterstrom is Clinical, and the taxonomy classification code that categorizes this area of expertise is 1041C0700X.
On what date did the Centers for Medicare & Medicaid Services assign the 1922163096 to Jack Lee Otterstrom?
The Centers for Medicare & Medicaid Services assigned the 1922163096 to Jack Lee Otterstrom on 2006-12-27.
When was the information pertaining to Jack Lee Otterstrom most recently updated or revised?
The details related to Jack Lee Otterstrom, including its address, specialty, and other relevant information, were last updated or revised on 2022-09-06.