Healthcare Provider Details

I. General information

NPI: 1740713734
Provider Name (Legal Business Name): JENIKA FERRETTI-GALLON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SE 172ND AVE STE 230
VANCOUVER WA
98684-9542
US

IV. Provider business mailing address

2525 NE 139TH ST
VANCOUVER WA
98686-2719
US

V. Phone/Fax

Practice location:
  • Phone: 360-882-2778
  • Fax:
Mailing address:
  • Phone: 360-882-2778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberA172106
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD89383
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: