38D1104174 CLIA NUMBER - JENNIFER WALLACE MD

Laboratory Demographics

  • CLIA Code: 38D1104174
  • Facility Name: JENNIFER WALLACE MD
  • Facility Address: 1235 SE DIVISION ST SUITE 208
    PORTLAND, OR
    ZIP 97202
  • Facility Phone: 888 480-1115
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JENNIFER L. WALLACE
  • NPI Number: 1730154154
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 38D1104174
LAB Type Physician Office
Facility Name JENNIFER WALLACE MD
Street 1235 SE DIVISION ST SUITE 208
City PORTLAND
State OR
ZIP 97202
Phone 888 480-1115
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/26/2025
Certificate Expiration Date 8/25/2027
Facility Type Physician Office
Lab Director JENNIFER L. WALLACE

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