Provider Demographics
NPI:1528953635
Name:WOODRUFF, GINA PANZA
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:PANZA
Last Name:WOODRUFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:PATRICA
Other - Last Name:PANZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12004 LADRIDO LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-6034
Mailing Address - Country:US
Mailing Address - Phone:512-554-7862
Mailing Address - Fax:
Practice Address - Street 1:1005 S MAYS ST
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-6725
Practice Address - Country:US
Practice Address - Phone:512-661-4387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
25-112221700000X
TX98046101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist