38D2316929 CLIA NUMBER - CLEMENTINE LAKE OSWEGO

Laboratory Demographics

  • CLIA Code: 38D2316929
  • Facility Name: CLEMENTINE LAKE OSWEGO
  • Facility Address: 22035 S WISTERIA RD
    WEST LINN, OR
    ZIP 97068
  • Facility Phone: 971 314-6530
  • Facility Type: Other - ITS PSYCH RESIDENT TREAT
  • Facility Type: Waiver
  • Lab Director: MOLLY M. PERLMAN
  • NPI Number: 1023562147
  • Taxonomy: 261QM0855X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 38D2316929
LAB Type Other - ITS PSYCH RESIDENT TREAT
Facility Name CLEMENTINE LAKE OSWEGO
Street 22035 S WISTERIA RD
City WEST LINN
State OR
ZIP 97068
Phone 971 314-6530
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/15/2025
Certificate Expiration Date 1/14/2027
Facility Type Other - ITS PSYCH RESIDENT TREAT
Lab Director MOLLY M. PERLMAN

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