24D0669702 CLIA NUMBER - ESSENTIA HEALTH HERMANTOWN CLINIC

Laboratory Demographics

  • CLIA Code: 24D0669702
  • Facility Name: ESSENTIA HEALTH HERMANTOWN CLINIC
  • Facility Address: 4855 W ARROWHEAD RD
    HERMANTOWN, MN
    ZIP 55811
  • Facility Phone: (218) 576-0448
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SANDRA MATTSON
  • NPI Number: 1003478892
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 24D0669702
LAB Type Physician Office
Facility Name ESSENTIA HEALTH HERMANTOWN CLINIC
Street 4855 W ARROWHEAD RD
City HERMANTOWN
State MN
ZIP 55811
Phone 2185760448
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: 5/18/2026