MEDICARE: MS. ELANAH DANIELLE WILSON

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
1	171M00000X	Case Manager/Care Coordinator
2	104100000X	Social Worker	18974	LA

General Provider Information

NPI Number	:	1508670993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELANAH DANIELLE WILSON

Provider Business Mailing Address
First Line	:	12097 OLD HAMMOND HWY STE F
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-8679
Country	:	US
Telephone Number	:	225-328-0826
Fax Number	:	225-302-5506

Provider Business Practice Location Address
First Line	:	12097 OLD HAMMOND HWY STE I4
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-8679
Country	:	US
Telephone Number	:	225-328-0826
Fax Number	:	225-302-5506

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2025
Last Update Date	:	02/11/2026

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