Shannon Wallace Ottens, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

139066 Issued in CA

Practice address

652 Petaluma Ave Ste H
Sebastopol, CA 95472-4266

Phone

(707) 823-3166

NPI assigned

Aug 24, 2023

Sex

Female

Sole proprietor

No

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 CA

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1692835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781481600000",
    "number": "1740064229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8531",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954071531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "652 PETALUMA AVE STE H",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "954724266",
            "telephone_number": "707-823-3166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTTENS",
        "first_name": "SHANNON",
        "middle_name": "WALLACE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-24",
        "last_updated": "2026-06-15",
        "certification_date": "2026-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "139066",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert S Oliver, DDS
• Mark E Olson, RPH
• Ryan Charles Olson, ND
• Sharon L Olson, D.O.
• Maria Iduvina Onofre, BACHELOR
• Pacific Rim Integrated Medical Group Inc
• Leslie Paige
• Palm Drive Health Care District
• Palm Drive Health Care District
• Palm Drive Health Care District

• Clinical Social Worker in Sebastopol, CA
• Providers in Sebastopol, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.