14D2237086 CLIA NUMBER - ILLINOIS CENTER FOR AUTISM

Laboratory Demographics

  • CLIA Code: 14D2237086
  • Facility Name: ILLINOIS CENTER FOR AUTISM
  • Facility Address: 548 S RUBY LN
    FAIRVIEW HEIGHTS, IL
    ZIP 62208
  • Facility Phone: 618 398-7500
  • Facility Type: School/Student Health Service
  • Facility Type: Waiver
  • Lab Director: TROY G. METHENEY
  • NPI Number: 1861587586
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 14D2237086
LAB Type School/Student Health Service
Facility Name ILLINOIS CENTER FOR AUTISM
Street 548 S RUBY LN
City FAIRVIEW HEIGHTS
State IL
ZIP 62208
Phone 618 398-7500
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/22/2025
Certificate Expiration Date 9/21/2027
Facility Type School/Student Health Service
Lab Director TROY G. METHENEY

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