52D2299818 CLIA NUMBER - JACKSON LAB SERVICES LLC

Laboratory Demographics

  • CLIA Code: 52D2299818
  • Facility Name: JACKSON LAB SERVICES LLC
  • Facility Address: 6001 W CENTER ST SUITE 97 LL
    MILWAUKEE, WI
    ZIP 53210
  • Facility Phone: 414 544-7445
  • Facility Type: Mobile Laboratory
  • Facility Type: Waiver
  • Lab Director: GEMONTASIA K. JACKSON
  • NPI Number: 1659149839
  • Taxonomy: 305S00000X - Point of Service

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CLIA Record

Field Name Field Value
CLIA Number 52D2299818
LAB Type Mobile Laboratory
Facility Name JACKSON LAB SERVICES LLC
Street 6001 W CENTER ST SUITE 97 LL
City MILWAUKEE
State WI
ZIP 53210
Phone 414 544-7445
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/27/2024
Certificate Expiration Date 2/26/2026
Facility Type Mobile Laboratory
Lab Director GEMONTASIA K. JACKSON

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