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

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Practice location Address checks out

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

Colleagues at Brightside Medical of Michigan PC

Clinicians the CMS Doctors & Clinicians file lists under the same group practice. CMS counts 93 clinicians in the practice; 12 are shown here.

Other providers in Bentonville