Healthcare Provider Details

I. General information

NPI: 1982214367
Provider Name (Legal Business Name): JENNI SHAW FUTCH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNI SHAW

II. Dates (important events)

Enumeration Date: 07/31/2020
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 E SUNBRIDGE DR
FAYETTEVILLE AR
72703-2894
US

IV. Provider business mailing address

65 E SUNBRIDGE DR
FAYETTEVILLE AR
72703-2894
US

V. Phone/Fax

Practice location:
  • Phone: 479-379-8604
  • Fax: 479-203-3286
Mailing address:
  • Phone: 479-379-8604
  • Fax: 479-203-3286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9532C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: