24D2309900 CLIA NUMBER - MODERN THERAPEUTICS

Laboratory Demographics

  • CLIA Code: 24D2309900
  • Facility Name: MODERN THERAPEUTICS
  • Facility Address: 200 SCHILLING DRIVE
    DUNDAS, MN
    ZIP 55019
  • Facility Phone: 612 488-2248
  • Facility Type: Other - KETAMINE CLINIC
  • Facility Type: Waiver
  • Lab Director: ASHLEY HANSON
  • NPI Number: 1356159891
  • Taxonomy: 207L00000X - Anesthesiology

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CLIA Record

Field Name Field Value
CLIA Number 24D2309900
LAB Type Other - KETAMINE CLINIC
Facility Name MODERN THERAPEUTICS
Street 200 SCHILLING DRIVE
City DUNDAS
State MN
ZIP 55019
Phone 612 488-2248
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/22/2024
Certificate Expiration Date 8/21/2026
Facility Type Other - KETAMINE CLINIC
Lab Director ASHLEY HANSON

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