# WYNN STREET LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ELECTRO GLOW ELECTROLOGY
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1730902941
- **Legal business name:** ELECTRO GLOW ELECTROLOGY
- **Authorized official:** JODI WYNN TURNER (OWNER/MANAGER)
- **Authorized official phone:** (971) 303-9360

## Contact information

- **Practice address:** 10445 SW CANYON RD STE 114, BEAVERTON, OR 97005-1913
- **Practice address phone:** (971) 303-9360
- **Mailing address:** 10445 SW CANYON RD STE 114, BEAVERTON, OR 97005-1913
- **Mailing address phone:** (971) 303-9360

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 156F00000X | Technician/Technologist | — | — | Yes |
| 246Z00000X | Other Specialist/Technologist | — | NULL | Yes |
| 246Z00000X | Other Specialist/Technologist | — | — | Yes |
| 247200000X | Other Technician | — | NULL | — |
| 247200000X | Other Technician | — | — | — |

## Other

- **Enumeration date:** 11/05/2024
- **Last updated:** 05/13/2026