38D1085645 CLIA NUMBER - NW PEDIATRICS INTEGRATIVE MEDICINE

Laboratory Demographics

  • CLIA Code: 38D1085645
  • Facility Name: NW PEDIATRICS INTEGRATIVE MEDICINE
  • Facility Address: 11790 SW BARNES RD BLDG A STE 140
    PORTLAND, OR
    ZIP 97225
  • Facility Phone: 503 643-2100
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: SHAUDINE R. WOODY
  • NPI Number: 1194987206
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 38D1085645
LAB Type Practitioner Other
Facility Name NW PEDIATRICS INTEGRATIVE MEDICINE
Street 11790 SW BARNES RD BLDG A STE 140
City PORTLAND
State OR
ZIP 97225
Phone 503 643-2100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/5/2024
Certificate Expiration Date 12/4/2026
Facility Type Practitioner Other
Lab Director SHAUDINE R. WOODY

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