15D0663987 CLIA NUMBER - LAGRANGE CO HEALTH DEPT WIC PROGRAM

Laboratory Demographics

  • CLIA Code: 15D0663987
  • Facility Name: LAGRANGE CO HEALTH DEPT WIC PROGRAM
  • Facility Address: 304 N TOWNLINE RD STE 1
    LAGRANGE, IN
    ZIP 46761
  • Facility Phone: 260 499-4182
  • Facility Type: Other - COVID TESTING SITE
  • Facility Type: Waiver
  • Lab Director: SUE ANN BICKLEY
  • NPI Number: 1720452014
  • Taxonomy: 251K00000X - Public Health or Welfare

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CLIA Record

Field Name Field Value
CLIA Number 15D0663987
LAB Type Other - COVID TESTING SITE
Facility Name LAGRANGE CO HEALTH DEPT WIC PROGRAM
Street 304 N TOWNLINE RD STE 1
City LAGRANGE
State IN
ZIP 46761
Phone 260 499-4182
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Other - COVID TESTING SITE
Lab Director SUE ANN BICKLEY

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This page was last updated on: 6/4/2025