Organization
CERTIFIED LAB SERVICES
Active
Other names
Certified Lab Services
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER A WALLACE MEDICAL ASSISTANT (OWNER/ OPERATOR)
(480) 685-7530
Entity
Organization
Contact information
Practice address
3123 FAIRVIEW AVE E STE 200, SEATTLE, WA 98102-3051
(480) 685-7530
(480) 900-8853
Mailing address
3123 FAIRVIEW AVE E STE 200, SEATTLE, WA 98102-3051
(480) 685-7530
(480) 900-8853
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
251K00000X
Public Health or Welfare Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QM2500X
Medical Specialty Clinic/Center
—
—
291U00000X
Clinical Medical Laboratory
—
—
305S00000X
Point of Service
—
—
310400000X
Assisted Living Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03D2197602
US DEPT OF HEALTH AND HUMAN SERVICES
AZ
01
—
PC61547365
PHLEBOTOMIST LICENSE
WA
Enumeration date
12/04/2020
Last updated
12/04/2024
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