Active NPI
Wynn Street LLC
- Other Specialist/Technologist
- Beaverton, OR
National Provider Identifier
1730902941
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Specialist/Technologist
- Legal business name
- WYNN STREET LLC
- Practice address
- 10445 SW Canyon Rd Ste 114
Beaverton, OR 97005-1913 - Phone
- (971) 303-9360
- NPI assigned
- Nov 5, 2024
- Last updated
- May 13, 2026
- Organization subpart
- Yes
- Parent organization
- ELECTRO GLOW ELECTROLOGY
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jodi Wynn Turner
- Title
- Owner/Manager
- Phone
- (971) 303-9360
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Other Technician | 247200000X | NU | ||
| Other Specialist/Technologist | 246Z00000X | NU | Primary |
Addresses
Primary practice location
10445 SW Canyon Rd Ste 114
Beaverton, OR 97005-1913
Mailing address
10445 SW Canyon Rd Ste 114
Beaverton, OR 97005-1913
Phone (971) 303-9360
National Provider Directory
National Provider Directory- Part of
- Wynn Street LLC
Locations
10445 SW Canyon Rd
Ste 114
Beaverton, OR 97005
Phone (971) 303-9360
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1730764800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1778630400000",
"number": "1730902941",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10445 SW CANYON RD STE 114",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970051913",
"telephone_number": "971-303-9360"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10445 SW CANYON RD STE 114",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970051913",
"telephone_number": "971-303-9360"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WYNN STREET LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "ELECTRO GLOW ELECTROLOGY",
"enumeration_date": "2024-11-05",
"last_updated": "2026-05-13",
"certification_date": "2026-05-13",
"status": "A",
"authorized_official_last_name": "TURNER",
"authorized_official_first_name": "JODI",
"authorized_official_middle_name": "WYNN",
"authorized_official_title_or_position": "OWNER/MANAGER",
"authorized_official_telephone_number": "971-303-9360"
},
"taxonomies": [
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "246Z00000X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beaverton, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.