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
—
—
247200000X
Other Technician
—
—
Other
Enumeration date
11/05/2024
Last updated
11/25/2024
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