Provider Demographics
NPI:1730576901
Name:OSTERHAUS, JOELLE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JOELLE
Middle Name:
Last Name:OSTERHAUS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5441 S MACADAM AVE STE R
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-6106
Mailing Address - Country:US
Mailing Address - Phone:503-956-7526
Mailing Address - Fax:
Practice Address - Street 1:24910 S DIANNE DR
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OR
Practice Address - Zip Code:97004-8702
Practice Address - Country:US
Practice Address - Phone:503-956-7526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-24
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL6643104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
93-0798039OtherTAX ID
456P24203OtherEIN
ORL6643OtherOREGON STATE BOARD OF SOCIAL WORK