52D2147489 CLIA NUMBER - PETERSON DERMATOLOGY SC

Laboratory Demographics

  • CLIA Code: 52D2147489
  • Facility Name: PETERSON DERMATOLOGY SC
  • Facility Address: 1204 N JOSEPH STREET
    DODGEVILLE, WI
    ZIP 53533
  • Facility Phone: (608) 574-5044
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MS. JENNIFER S. PETERSON
  • NPI Number: 1023406493
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 52D2147489
LAB Type Physician Office
Facility Name PETERSON DERMATOLOGY SC
Street 1204 N JOSEPH STREET
City DODGEVILLE
State WI
ZIP 53533
Phone 6085745044
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/20/2026
Certificate Expiration Date 4/19/2028
Facility Type Physician Office
Lab Director MS. JENNIFER S. PETERSON

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This page was last updated on: 5/18/2026