15D0663338 CLIA NUMBER - MARSHALL COUNTY WIC PROGRAM

Laboratory Demographics

  • CLIA Code: 15D0663338
  • Facility Name: MARSHALL COUNTY WIC PROGRAM
  • Facility Address: 510 W ADAMS, #240
    PLYMOUTH, IN
    ZIP 46563
  • Facility Phone: 574 936-8208
  • Facility Type: Other - WIC OFFICE
  • Facility Type: Waiver
  • Lab Director: LESLIE MILLER
  • NPI Number: 1629103684
  • Taxonomy: 332U00000X - Home Delivered Meals

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CLIA Record

Field Name Field Value
CLIA Number 15D0663338
LAB Type Other - WIC OFFICE
Facility Name MARSHALL COUNTY WIC PROGRAM
Street 510 W ADAMS, #240
City PLYMOUTH
State IN
ZIP 46563
Phone 574 936-8208
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Other - WIC OFFICE
Lab Director LESLIE MILLER

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