Healthcare Provider Details

I. General information

NPI: 1760521579
Provider Name (Legal Business Name): JENNIFER A MARNIK-SCALICI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S SCHEUBER RD PMG SW WA CENTRALIA WOMEN CENTER
CENTRALIA WA
98531-8877
US

IV. Provider business mailing address

PO BOX 3360
PORTLAND OR
97208-3360
US

V. Phone/Fax

Practice location:
  • Phone: 360-330-8950
  • Fax: 360-330-8955
Mailing address:
  • Phone: 360-486-6508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number02008733A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberOP00002252
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: