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Organization
WYNN STREET LLC
Active
Organization
WYNN STREET LLC
Active
Parent organization
ELECTRO GLOW ELECTROLOGY
Organization subpart
Yes
Provider details
NPI number
Legal business name
ELECTRO GLOW ELECTROLOGY
Authorized official
JODI WYNN TURNER (OWNER/MANAGER)
(971) 303-9360
Entity
Organization
Contact information
Practice address
10445 SW CANYON RD STE 114, BEAVERTON, OR 97005-1913
(971) 303-9360
Mailing address
10445 SW CANYON RD STE 114, BEAVERTON, OR 97005-1913
(971) 303-9360
Taxonomy
Speciality
Code
Description
License number
State
156F00000X
Technician/Technologist
Primary
—
—
246Z00000X
Other Specialist/Technologist
Primary
—
NULL
246Z00000X
Other Specialist/Technologist
Primary
—
—
247200000X
Other Technician
—
NULL
247200000X
Other Technician
—
—
Other
Enumeration date
11/05/2024
Last updated
05/13/2026
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