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

Individual provider Clinical Social Worker · NPI 1598505513

Michelle Wise Gendusa, LICSW is a Clinical Social Worker in Fayetteville, Arkansas. Qualified in 1997, 29 years ago. Practices as a sole proprietor, accepts Medicare assignment and offers telehealth. Licensed in Arkansas and Washington.

Years since qualifying
29
Licensed in
AR, WA
In the registry since
2024
Specialties on file
2
What do these letters mean?
LICSW — Licensed Independent Clinical Social Worker
The title some states use for an independently practising clinical social worker.

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Practice location Address checks out

3546 W Greystone Dr
Fayetteville, AR 72764
Phone: (509) 434-6386
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 22926-C (AR)
Clinical Social Worker Taxonomy 1041C0700X · Licence LW60479720 (WA)

Record details

NPI number1598505513
Entity typeIndividual (Type 1)
GenderFemale
Credentials LICSW
Sole proprietorYes
NPI enumeratedMay 28, 2024
Last updated in NPPESJanuary 26, 2025
Certification dateJanuary 26, 2025

Medicare enrollment

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

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 1997 (29 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

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