14D2156478 CLIA NUMBER - WELL-ROOTED PEDIATRICS L L C

Laboratory Demographics

  • CLIA Code: 14D2156478
  • Facility Name: WELL-ROOTED PEDIATRICS L L C
  • Facility Address: 390 E CONGRESS PKWY - STE I
    CRYSTAL LAKE, IL
    ZIP 60014
  • Facility Phone: 815 355-1605
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JESSICA L. PAWLICKI
  • NPI Number: 1780157602
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 14D2156478
LAB Type Physician Office
Facility Name WELL-ROOTED PEDIATRICS L L C
Street 390 E CONGRESS PKWY - STE I
City CRYSTAL LAKE
State IL
ZIP 60014
Phone 815 355-1605
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/18/2024
Certificate Expiration Date 10/17/2026
Facility Type Physician Office
Lab Director JESSICA L. PAWLICKI

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