Organization
ST. XAXIER UNIVERSITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DIANE MARIE MACKOWIAK M.S. (SPEECH/LANGUAGE PATHOLOGY CLINICAL)
(773) 298-3559
Entity
Organization
Contact information
Practice address
3825 W 103RD ST, CHICAGO, IL 60655-3700
(773) 298-3559
Mailing address
3825 W 103RD ST, CHICAGO, IL 60655-3700
(773) 298-3559
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
146.001000
IL
Other
Enumeration date
01/24/2012
Last updated
01/24/2012
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