MR. JACK LEE OTTERSTROM (NPI# 1922163096) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922163096 |
| Entity Type | Individual |
| Full Name | MR. JACK LEE OTTERSTROM |
| Other Name | MR. JAY LEE OTTERSTRO |
| Credential | LCSW |
| Practice Address |
250 W Marquam St Mount Angel OR 97362-9520 |
| Mailing Address |
Po Box 278 Woodburn OR 97071-0278 |
| Practice Telephone | 9719835214 |
| Practice Fax Number | 9719835219 |
| Mailing Telephone | 9719835260 |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2017-05-18 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YP2500X |
Counselor Specialization: Professional |
L5316 | OR | Behavioral Health & Social Service Providers |
| N | 1041C0700X |
Social Worker Specialization: Clinical |
L3516 | OR | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | R145387 | 05 |
| Street Address |
250 W MARQUAM ST |
| City | MOUNT ANGEL |
| State | OR |
| Zip Code | 97362-9520 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528171543 | Silverton Health | Clinic/Center | 250 W Marquam St, Mount Angel, OR 97362-9520 | 2006-08-16 |
| 1902207830 | Jennie Jorgensen | Social Worker | 250 W Marquam St, Mount Angel, OR 97362-9520 | 2014-09-10 |
| 1215230651 | Jess Ransom Miller | Family Medicine | 250 W Marquam St, Mount Angel, OR 97362 | 2010-12-07 |
| 1669691721 | Heidi Margarita Abreu Pacheco | Internal Medicine | 250 W Marquam St, Mount Angel, OR 97362 | 2007-04-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912321308 | Michael John Petracci | Chiropractor | 690 N Main St, Mount Angel, OR 97362 | 2014-02-06 |
| 1750630695 | Amy Roth | Occupational Therapist | 540 S. Main St, Mt. Angel, OR 97362-0000 | 2012-09-06 |
| 1356989271 | Brittany Micaela Curths | Behavior Technician | 315 S Pershing St, Mount Angel, OR 97362-9508 | 2019-12-11 |
| 1942268354 | Faith L. Koschmann | Family Medicine | 690 N Main St, Mount Angel, OR 97362-9518 | 2006-05-03 |
| 1760801310 | Foundations Health and Wellness Center LLC | Chiropractor | 690 N Main St, Mount Angel, OR 97362-9518 | 2014-04-10 |
| 1972644250 | Charles D Hyde | Nurse Practitioner | 690 N Main St, Mount Angel, OR 97362-9518 | 2007-02-09 |
| 1437107083 | James Edward Domst | Family Medicine | 690 N Main St, Mount Angel, OR 97362-9518 | 2006-05-05 |
| 1962450551 | Mayda Ramos | Internal Medicine | 690 N Main St, Mount Angel, OR 97362-9518 | 2006-05-05 |
| 1962844241 | Providence Health & Services-oregon | Hospice Care, Community Based | 580 S Main St, Mount Angel, OR 97362-9540 | 2013-07-26 |
| 1831196302 | Providence Health & Services Oregon | Home Health | 570 S Main Street, Mount Angel, OR 97362-9540 | 2005-06-30 |
| Find all providers in zip 97362 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326649005 | Birgit Essl | Counselor | 925 Nw Wall St Ste 203, Bend, OR 97703-2052 | 2020-11-08 |
| 1063013373 | Ruth Tessema | Counselor | 2120 Ne 166th Dr, Portland, OR 97230-5558 | 2020-11-03 |
| 1578161964 | Joyful Living Behavioral Health Inc | Counselor | 107 W Q St, Springfield, OR 97477-2171 | 2020-10-16 |
| 1598362626 | Ascension Counseling LLC | Counselor | 15 Sw Colorado Ave Ste 127, Bend, OR 97702-1229 | 2020-10-01 |
| 1902413297 | Barbara Jenkins Jenkins Lehman | Counselor | 131 Nw Hawthorne Ave Ste 102, Bend, OR 97703-2957 | 2020-09-30 |
| 1326654021 | Lori Michelle Severson | Counselor | 12250 Sw 2nd St Ste B-103, Beaverton, OR 97005-2828 | 2020-09-17 |
| 1063020691 | Coastal Counseling & Consulting LLC | Counselor | 1638 N Coast Hwy, Newport, OR 97365-2357 | 2020-07-20 |
| 1326656240 | Donald Marks | Counselor | 7901 Se Powell Blvd Ste B251, Portland, OR 97206-2314 | 2020-07-16 |
| 1831707058 | Toni Lynn Bellinger | Counselor | 14523 Westlake Dr # 2, Lake Oswego, OR 97035-7700 | 2020-07-14 |
| 1831717800 | Marty Alan Michelson | Counselor | 609 Ne Baker St Ste 208, Mcminnville, OR 97128-4946 | 2020-07-07 |
| Find all providers with the same taxonomy | ||||
| City | MOUNT ANGEL |
| Zip Code | 97362 |
Please comment or provide details below to improve the information on MR. JACK LEE OTTERSTROM.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.