52D2193780 CLIA NUMBER - RED OAK COUNSELING, LTD

Laboratory Demographics

  • CLIA Code: 52D2193780
  • Facility Name: RED OAK COUNSELING, LTD
  • Facility Address: 12970 W BLUEMOUND RD #200
    ELM GROVE, WI
    ZIP 53122
  • Facility Phone: 262 780-1020
  • Facility Type: Independent
  • Facility Type: Waiver
  • Lab Director: MR. KEVIN POLKY
  • NPI Number: 1609890391
  • Taxonomy: 261QM0801X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 52D2193780
LAB Type Independent
Facility Name RED OAK COUNSELING, LTD
Street 12970 W BLUEMOUND RD #200
City ELM GROVE
State WI
ZIP 53122
Phone 262 780-1020
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/24/2024
Certificate Expiration Date 9/23/2026
Facility Type Independent
Lab Director MR. KEVIN POLKY

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