38D0624574 CLIA NUMBER - CLACKAMAS DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 38D0624574
  • Facility Name: CLACKAMAS DERMATOLOGY
  • Facility Address: 12605 SE 97TH AVE
    CLACKAMAS, OR
    ZIP 97015
  • Facility Phone: 503 654-7546
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: PAUL J. AANDERUD
  • NPI Number: 1689702722
  • Taxonomy: 225100000X - Physical Therapist

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CLIA Record

Field Name Field Value
CLIA Number 38D0624574
LAB Type Physician Office
Facility Name CLACKAMAS DERMATOLOGY
Street 12605 SE 97TH AVE
City CLACKAMAS
State OR
ZIP 97015
Phone 503 654-7546
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 8/7/2025
Certificate Expiration Date 8/6/2027
Facility Type Physician Office
Lab Director PAUL J. AANDERUD

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