20D1048544 CLIA NUMBER - WABANAKI PUBLIC HEALTH AND WELLNESS

Laboratory Demographics

  • CLIA Code: 20D1048544
  • Facility Name: WABANAKI PUBLIC HEALTH AND WELLNESS
  • Facility Address: 157 PARK STREET
    BANGOR, ME
    ZIP 04401
  • Facility Phone: 207 631-1536
  • Facility Type: Public Health Laboratories
  • Facility Type: Waiver
  • Lab Director: SHARON TOMAH JORDAN
  • NPI Number: 1689335184
  • Taxonomy: 103TA0400X - Psychologist

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CLIA Record

Field Name Field Value
CLIA Number 20D1048544
LAB Type Public Health Laboratories
Facility Name WABANAKI PUBLIC HEALTH AND WELLNESS
Street 157 PARK STREET
City BANGOR
State ME
ZIP 04401
Phone 207 631-1536
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/5/2023
Certificate Expiration Date 12/4/2025
Facility Type Public Health Laboratories
Lab Director SHARON TOMAH JORDAN

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This page was last updated on: 3/20/2025