25D2312365 CLIA NUMBER - GAUTIER WELLNESS LLC

Laboratory Demographics

  • CLIA Code: 25D2312365
  • Facility Name: GAUTIER WELLNESS LLC
  • Facility Address: 14805 BURRELL RD
    VANCLEAVE, MS
    ZIP 39565
  • Facility Phone: 816 448-9515
  • Facility Type: Other - TEMPORARY TESTING
  • Facility Type: Waiver
  • Lab Director: ALICIA GATZ
  • NPI Number: 1710715370
  • Taxonomy: 293D00000X - Physiological Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 25D2312365
LAB Type Other - TEMPORARY TESTING
Facility Name GAUTIER WELLNESS LLC
Street 14805 BURRELL RD
City VANCLEAVE
State MS
ZIP 39565
Phone 816 448-9515
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/9/2024
Certificate Expiration Date 10/8/2026
Facility Type Other - TEMPORARY TESTING
Lab Director ALICIA GATZ

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