Jacklyn Ewald, LPC

Primary specialty

Health Service PsychologistTaxonomy code 103TH0100X

License

R389 Issued in OR

Practice address

21900 Willamette Dr Ste 202
West Linn, OR 97068-3284

Phone

(503) 653-0631

NPI assigned

Jan 29, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sundstrom Clinical Services LLC

  • Psychologist
  • West Linn, OR
  • NPI 1669508412
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1548720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783814400000",
    "number": "1003370578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21900 WILLAMETTE DR STE 202",
            "city": "WEST LINN",
            "state": "OR",
            "postal_code": "970683284",
            "telephone_number": "503-653-0631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21900 WILLAMETTE DR STE 202",
            "city": "WEST LINN",
            "state": "OR",
            "postal_code": "970683284",
            "telephone_number": "503-653-0631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EWALD",
        "first_name": "JACKLYN",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-29",
        "last_updated": "2026-07-12",
        "certification_date": "2026-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TH0100X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health Service",
            "state": "OR",
            "license": "R389",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "C.1902396",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Enser
• Jessica L Erb, QMHA-R
• Veronica Esagui
• Leasel Wayne Evans, RN, MSN, PMHNP-BC
• Allison Karly Everson, PA-C
• Eyedeology, Inc
• Ralph Ezagui, D.C.
• Jason Nathaniel Faber
• Farnaz Dana Fakhari, MD
• Family Foot Clinic LLC

• Health Service Psychologist in West Linn, OR
• Providers in West Linn, OR by specialty
• Health Service Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.