24D0404121 CLIA NUMBER - ESSENTIA HEALTH LAKEWALK CLINIC

Laboratory Demographics

  • CLIA Code: 24D0404121
  • Facility Name: ESSENTIA HEALTH LAKEWALK CLINIC
  • Facility Address: 1502 LONDON ROAD
    DULUTH, MN
    ZIP 55812
  • Facility Phone: 218 576-0448
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SANDRA MATTSON
  • NPI Number: 1275839193
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 24D0404121
LAB Type Physician Office
Facility Name ESSENTIA HEALTH LAKEWALK CLINIC
Street 1502 LONDON ROAD
City DULUTH
State MN
ZIP 55812
Phone 218 576-0448
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/1/2025
Certificate Expiration Date 9/30/2027
Facility Type Physician Office
Lab Director SANDRA MATTSON

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