Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jeanie Ray Shade, LCSW

Individual provider Clinical Social Worker · NPI 1659048809

Jeanie Ray Shade, LCSW is a Clinical Social Worker in Bentonville, Arkansas. Qualified in 2010, 16 years ago. Practices with Brightside Medical of Michigan PC, a 93-clinician group and accepts Medicare assignment. Licensed in Arkansas.

Years since qualifying
16
Licensed in
AR
In the registry since
2021
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

See every abbreviation used in this directory →

Claim this listing Report a problem Suggest an edit

Practice location Address checks out

1001 SE 28th St
Bentonville, AR 72712-3205
Phone: (479) 403-2915
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 12579-C (AR)

Record details

NPI number1659048809
Entity typeIndividual (Type 1)
GenderFemale
Credentials LCSW
Sole proprietorYes
NPI enumeratedAugust 25, 2021
Last updated in NPPESDecember 6, 2023
Certification dateDecember 6, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2010 (16 years in practice)
Group practice Brightside Medical Of Michigan Pc — 93 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Bentonville