Wildwood Electrolysis LLC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

WILDWOOD ELECTROLYSIS LLC

Practice address

833 SE Main St Ste 106
Portland, OR 97214-3410

Phone

(503) 251-5902

NPI assigned

Jan 7, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shay Forest Witten, LENPI 1912729898

Title

Owner/Electrologist

Phone

(541) 805-9282

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shay Forest Witten

  • Specialist
  • Portland, OR
  • NPI 1912729898
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1736208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736208000000",
    "number": "1639989205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8803 N TYNDALL AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972177029",
            "telephone_number": "541-805-9282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "833 SE MAIN ST STE 106",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972143410",
            "telephone_number": "503-251-5902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILDWOOD ELECTROLYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-07",
        "last_updated": "2025-01-07",
        "certification_date": "2025-01-07",
        "status": "A",
        "authorized_official_last_name": "WITTEN",
        "authorized_official_first_name": "SHAY",
        "authorized_official_middle_name": "FOREST",
        "authorized_official_title_or_position": "OWNER/ELECTROLOGIST",
        "authorized_official_telephone_number": "541-805-9282",
        "authorized_official_credential": "LE"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Portland, OR
• Providers in Portland, OR by specialty
• Specialist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.