Shandra Thea Rotenberry, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LW60854195 Issued in WA

Practice address

23505 E Appleway Ave Ste 200-540
Liberty Lake, WA 99019-6065

Phone

(253) 465-2236

NPI assigned

Jan 8, 2019

Last updated

May 3, 2026By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mindful Therapy Group PCGroup PAC ID 4981872561, 654 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Mindful Therapy Group PC

  dba Mindful Therapy Group

  • Clinical Social Worker
  • Mountlake Terrace, WA
  • NPI 1316238678
  Medicare reassignment Care Compare group NPD
• Therapy Corner & Consulting, Professional Corporation

  • Clinical Social Worker
  • Liberty Lake, WA
  • NPI 1508700287
  NPD Authorized official

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

{
    "created_epoch": "1546905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777766400000",
    "number": "1053884528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1484 MARION COUNTY 4003",
            "city": "YELLVILLE",
            "state": "AR",
            "postal_code": "726879343",
            "telephone_number": "714-356-8077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23505 E APPLEWAY AVE STE 200-540",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990196065",
            "telephone_number": "253-465-2236"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1030 N Center Pkwy",
            "address_purpose": "LOCATION",
            "city": "Kennewick",
            "state": "WA",
            "postal_code": "993367160",
            "country_code": "US",
            "telephone_number": "253-465-2236",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1106 Clayton Ln Ste 501W",
            "address_purpose": "LOCATION",
            "city": "Austin",
            "state": "TX",
            "postal_code": "787231085",
            "country_code": "US",
            "telephone_number": "253-465-2236",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3537 N Steele Blvd Ste 110",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "AR",
            "postal_code": "727035631",
            "country_code": "US",
            "telephone_number": "253-465-2236",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROTENBERRY",
        "first_name": "SHANDRA",
        "middle_name": "THEA",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-01-08",
        "last_updated": "2026-05-03",
        "certification_date": "2026-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW60854195",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kyle P Robles, PA-C
• Rockwood Clinic PS (Rockwood Urgent Care-Liberty Lake)
• Rockwood Clinic PS (Rockwood Liberty Lake)
• Chantel Rose Rogge, LMT
• Jean M Rohrer, CRNP MSN
• Bryan Rubin
• Xiola Sabastian
• Carrie Sarff, LMP
• Amy Karen Schaffner, FNP-BC
• Bradley Schuldt

• Clinical Social Worker in Liberty Lake, WA
• Providers in Liberty Lake, WA by specialty
• Clinical Social Worker in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.