17D2175451 CLIA NUMBER - SOMA RECOVERY

Laboratory Demographics

  • CLIA Code: 17D2175451
  • Facility Name: SOMA RECOVERY
  • Facility Address: 825 N WACO AVE
    WICHITA, KS
    ZIP 67203
  • Facility Phone: 316 201-6047
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: LAVETA M. JARRETT
  • NPI Number: 1750850723
  • Taxonomy: 101YM0800X - Counselor

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CLIA Record

Field Name Field Value
CLIA Number 17D2175451
LAB Type Practitioner Other
Facility Name SOMA RECOVERY
Street 825 N WACO AVE
City WICHITA
State KS
ZIP 67203
Phone 316 201-6047
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/21/2023
Certificate Expiration Date 11/20/2025
Facility Type Practitioner Other
Lab Director LAVETA M. JARRETT

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