Provider Demographics
NPI:1760521579
Name:MARNIK-SCALICI, JENNIFER A (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:A
Last Name:MARNIK-SCALICI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3360
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3360
Mailing Address - Country:US
Mailing Address - Phone:360-486-6508
Mailing Address - Fax:
Practice Address - Street 1:1000 S SCHEUBER RD
Practice Address - Street 2:PMG SW WA CENTRALIA WOMEN CENTER
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-8877
Practice Address - Country:US
Practice Address - Phone:360-330-8950
Practice Address - Fax:360-330-8955
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00002252207VX0000X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8500928Medicaid
WA8500928Medicaid