13D1044436 CLIA NUMBER - DEBLIECK DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 13D1044436
  • Facility Name: DEBLIECK DERMATOLOGY
  • Facility Address: 13176 W PERSIMMON LN
    BOISE, ID
    ZIP 83713
  • Facility Phone: 208 939-5030
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: JENNIFER A. DEBLIECK
  • NPI Number: 1497960983
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 13D1044436
LAB Type Physician Office
Facility Name DEBLIECK DERMATOLOGY
Street 13176 W PERSIMMON LN
City BOISE
State ID
ZIP 83713
Phone 208 939-5030
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 1/24/2024
Certificate Expiration Date 1/23/2026
Facility Type Physician Office
Lab Director JENNIFER A. DEBLIECK

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This page was last updated on: 9/29/2025