Provider Demographics
NPI:1982796413
Name:WOODENLEGS, GAYLA G (LAC)
Entity type:Individual
Prefix:
First Name:GAYLA
Middle Name:G
Last Name:WOODENLEGS
Suffix:
Gender:F
Credentials:LAC
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 304
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-0304
Mailing Address - Country:US
Mailing Address - Phone:360-739-9272
Mailing Address - Fax:
Practice Address - Street 1:2076 MAIN ST
Practice Address - Street 2:SUITE #2
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-9468
Practice Address - Country:US
Practice Address - Phone:360-739-9272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000631171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist