52D2121918 CLIA NUMBER - PROFESSIONAL SERVICES GROUP - WEST ALLIS

Laboratory Demographics

  • CLIA Code: 52D2121918
  • Facility Name: PROFESSIONAL SERVICES GROUP - WEST ALLIS
  • Facility Address: 1205 S 70TH STREET SUITE 401
    WEST ALLIS, WI
    ZIP 53214
  • Facility Phone: 414 475-2788
  • Facility Type: Other - MENTAL HLTH CLINIC AODA
  • Facility Type: Waiver
  • Lab Director: DR. JONATHON GRAPENGIESER
  • NPI Number: 1598080525
  • Taxonomy: 101YM0800X - Counselor

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CLIA Record

Field Name Field Value
CLIA Number 52D2121918
LAB Type Other - MENTAL HLTH CLINIC AODA
Facility Name PROFESSIONAL SERVICES GROUP - WEST ALLIS
Street 1205 S 70TH STREET SUITE 401
City WEST ALLIS
State WI
ZIP 53214
Phone 414 475-2788
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/16/2024
Certificate Expiration Date 11/15/2026
Facility Type Other - MENTAL HLTH CLINIC AODA
Lab Director DR. JONATHON GRAPENGIESER

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