52D2313461 CLIA NUMBER - HAZELDEN BETTY FORD - HUDSON

Laboratory Demographics

  • CLIA Code: 52D2313461
  • Facility Name: HAZELDEN BETTY FORD - HUDSON
  • Facility Address: 900 CREST VIEW DR STE 120
    HUDSON, WI
    ZIP 54016
  • Facility Phone: 651 292-2434
  • Facility Type: Other - OUTPATIENT SUD
  • Facility Type: Waiver
  • Lab Director: DR. ALTA DEROO
  • NPI Number: 1972363240
  • Taxonomy: 261QR0405X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 52D2313461
LAB Type Other - OUTPATIENT SUD
Facility Name HAZELDEN BETTY FORD - HUDSON
Street 900 CREST VIEW DR STE 120
City HUDSON
State WI
ZIP 54016
Phone 651 292-2434
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/31/2024
Certificate Expiration Date 10/30/2026
Facility Type Other - OUTPATIENT SUD
Lab Director DR. ALTA DEROO

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