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NPI Code Detail

MEDICARE: WENONA JEAN MELLOTT BSW

MEDICARE: WENONA JEAN MELLOTT BSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker18234LA

General Provider Information

NPI Number : 1467004978
Entity Type Code : Individual
Provider Name (Legal Business Name) : WENONA JEAN MELLOTT BSW
Provider Business Mailing Address
First Line : 350 GATEWAY DR
Second Line :
City : SLIDELL
State : LA
Zip : 70461-5589
Country : US
Telephone Number : 985-707-1410
Fax Number :
Provider Business Practice Location Address
First Line : 350 GATEWAY DR
Second Line :
City : SLIDELL
State : LA
Zip : 70461-5589
Country : US
Telephone Number : 985-707-1410
Fax Number : 985-707-1415
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2019
Last Update Date : 04/23/2026

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Directions to “ WENONA JEAN MELLOTT BSW” Practice Location

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