Organization
CONSULTANTS LABORATORY OF WISCONSIN, LLC
Active
Parent organization
CONSULTANTS LABORATORY OF WISCONSIN, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
CONSULTANTS LABORATORY OF WISCONSIN, LLC
Authorized official
DEBORAH L CHRISTIAN (SUPERVISOR REVENUE CYCLE)
(920) 926-5840
Entity
Organization
Contact information
Practice address
790 EASTGATE DR, RIPON, WI 54971
(920) 929-9300
Mailing address
430 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 929-9300
(920) 926-8900
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
52D1104620
CLIA CERTIFICATION
WI
Enumeration date
10/01/2009
Last updated
12/16/2022
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