MEDICARE: YOLANDA BUTLER MARIONEAUX

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		LA

General Provider Information

NPI Number	:	1619756723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOLANDA BUTLER MARIONEAUX

Provider Business Mailing Address
First Line	:	8326 KELWOOD AVE
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-4803
Country	:	US
Telephone Number	:	888-693-4996
Fax Number	:

Provider Business Practice Location Address
First Line	:	118 VILLAGE ST STE A
Second Line	:
City	:	SLIDELL
State	:	LA
Zip	:	70458-5302
Country	:	US
Telephone Number	:	985-781-4444
Fax Number	:

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

Provider Enumeration Date	:	09/27/2023
Last Update Date	:	04/14/2026

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