52D2090378 CLIA NUMBER - OZAUKEE COUNTY

Laboratory Demographics

  • CLIA Code: 52D2090378
  • Facility Name: OZAUKEE COUNTY
  • Facility Address: 121 W MAIN ST, 4TH FLOOR
    PORT WASHINGTON, WI
    ZIP 53074
  • Facility Phone: 262 284-8200
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: SAMANTHA G. DAGENHARDT
  • NPI Number: 1609867001
  • Taxonomy: 261QM0801X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 52D2090378
LAB Type Community Clinic
Facility Name OZAUKEE COUNTY
Street 121 W MAIN ST, 4TH FLOOR
City PORT WASHINGTON
State WI
ZIP 53074
Phone 262 284-8200
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/22/2025
Certificate Expiration Date 1/21/2027
Facility Type Community Clinic
Lab Director SAMANTHA G. DAGENHARDT

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