Provider Demographics
NPI:1336959964
Name:WOODGATE, JOHN GALLOWAY
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:GALLOWAY
Last Name:WOODGATE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21236 NE 12TH ST
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-6740
Mailing Address - Country:US
Mailing Address - Phone:425-503-9641
Mailing Address - Fax:
Practice Address - Street 1:6306 215TH ST SW STE 3
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-6025
Practice Address - Country:US
Practice Address - Phone:425-224-6255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent