52D2170024 CLIA NUMBER - PROFESSIONAL SERVICES GROUP

Laboratory Demographics

  • CLIA Code: 52D2170024
  • Facility Name: PROFESSIONAL SERVICES GROUP
  • Facility Address: 2108 63RD STREET
    KENOSHA, WI
    ZIP 53143
  • Facility Phone: 262 652-2406
  • Facility Type: Other - MENTAL HEALTH CLINIC/AODA
  • Facility Type: Waiver
  • Lab Director: DR. LEAH FEATHERSTONE
  • NPI Number: 1124104740
  • Taxonomy: 101YM0800X - Counselor

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CLIA Record

Field Name Field Value
CLIA Number 52D2170024
LAB Type Other - MENTAL HEALTH CLINIC/AODA
Facility Name PROFESSIONAL SERVICES GROUP
Street 2108 63RD STREET
City KENOSHA
State WI
ZIP 53143
Phone 262 652-2406
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/31/2025
Certificate Expiration Date 7/30/2027
Facility Type Other - MENTAL HEALTH CLINIC/AODA
Lab Director DR. LEAH FEATHERSTONE

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