Individual
JEANIE RAY SHADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1001 SE 28TH ST, BENTONVILLE, AR 72712-3205
(479) 403-2915
Mailing address
53 NANTUCKET DR, BELLA VISTA, AR 72715-8178
(208) 749-4323
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
12579-C
AR
Other
Enumeration date
08/25/2021
Last updated
12/06/2023
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