# ST. XAXIER UNIVERSITY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689945578
- **Authorized official:** MRS. DIANE MARIE MACKOWIAK M.S. (SPEECH/LANGUAGE PATHOLOGY CLINICAL)
- **Authorized official phone:** (773) 298-3559

## Contact information

- **Practice address:** 3825 W 103RD ST, CHICAGO, IL 60655-3700
- **Practice address phone:** (773) 298-3559
- **Mailing address:** 3825 W 103RD ST, CHICAGO, IL 60655-3700
- **Mailing address phone:** (773) 298-3559

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 146.001000 | IL | Yes |

## Other

- **Enumeration date:** 01/24/2012
- **Last updated:** 01/24/2012