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General NPI Number Information
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NPI Number | 1689945578
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Entity Type | Organization
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Legal Business Name | ST. XAXIER UNIVERSITY
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Dates
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Enumeration Date | 01/24/2012
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Last Update Date | 01/24/2012
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Provider Practice Location Address
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Address Line | 3825 W 103RD ST
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City | CHICAGO
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State | IL
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Zip | 60655-3700
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Country | US
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Telephone | 773-298-3559
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Fax |
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Provider Business Mailing Address
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Address Line | 3825 W 103RD ST
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City | CHICAGO
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State | IL
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Zip | 60655-3700
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Country | US
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Telephone | 773-298-3559
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Fax |
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Authorized Official
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Title or Position | SPEECH/LANGUAGE PATHOLOGY CLINICAL
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Name | MRS. DIANE MARIE MACKOWIAK
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Credential | M.S.
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Telephone | 773-298-3559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 146.001000
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License Number State | IL
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