38D2313450 CLIA NUMBER - STUMPTOWN LAB SERVICES LLC

Laboratory Demographics

  • CLIA Code: 38D2313450
  • Facility Name: STUMPTOWN LAB SERVICES LLC
  • Facility Address: 1355 NW EVERETT ST, STE 100
    PORTLAND, OR
    ZIP 97209
  • Facility Phone: 971 433-5334
  • Facility Type: Mobile Laboratory
  • Facility Type: Waiver
  • Lab Director: TADHG L. SHANNON
  • NPI Number: 1326869579
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 38D2313450
LAB Type Mobile Laboratory
Facility Name STUMPTOWN LAB SERVICES LLC
Street 1355 NW EVERETT ST, STE 100
City PORTLAND
State OR
ZIP 97209
Phone 971 433-5334
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/31/2024
Certificate Expiration Date 10/30/2026
Facility Type Mobile Laboratory
Lab Director TADHG L. SHANNON

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