24D0399071 CLIA NUMBER - FAMILY TREE CLINIC

Laboratory Demographics

  • CLIA Code: 24D0399071
  • Facility Name: FAMILY TREE CLINIC
  • Facility Address: 1919 NICOLLET AVE
    MINNEAPOLIS, MN
    ZIP 55403
  • Facility Phone: 612 473-0819
  • Facility Type: Community Clinic
  • Facility Type: Microscopy
  • Lab Director: KAITLYN VASKE-WRIGHT
  • NPI Number: 1952417412
  • Taxonomy: 261QA0005X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 24D0399071
LAB Type Community Clinic
Facility Name FAMILY TREE CLINIC
Street 1919 NICOLLET AVE
City MINNEAPOLIS
State MN
ZIP 55403
Phone 612 473-0819
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 8/1/2024
Certificate Expiration Date 7/31/2026
Facility Type Community Clinic
Lab Director KAITLYN VASKE-WRIGHT

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