Organization
WILDWOOD ELECTROLYSIS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAY FOREST WITTEN LE (OWNER/ELECTROLOGIST)
(541) 805-9282
Entity
Organization
Contact information
Practice address
833 SE MAIN ST STE 106, PORTLAND, OR 97214-3410
(503) 251-5902
Mailing address
8803 N TYNDALL AVE, PORTLAND, OR 97217-7029
(541) 805-9282
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
01/07/2025
Last updated
01/07/2025
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