24D2134350 CLIA NUMBER - MODERN MOJO

Laboratory Demographics

  • CLIA Code: 24D2134350
  • Facility Name: MODERN MOJO
  • Facility Address: 28 NW 4TH STREET SUITE A
    GRAND RAPIDS, MN
    ZIP 55744
  • Facility Phone: 218 999-7750
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: TRACY ANN ZIMMERMAN-DESCHEPPER
  • NPI Number: 1902344591
  • Taxonomy: 261QM0801X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 24D2134350
LAB Type Physician Office
Facility Name MODERN MOJO
Street 28 NW 4TH STREET SUITE A
City GRAND RAPIDS
State MN
ZIP 55744
Phone 218 999-7750
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/1/2025
Certificate Expiration Date 7/31/2027
Facility Type Physician Office
Lab Director TRACY ANN ZIMMERMAN-DESCHEPPER

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