Provider Demographics
NPI:1962773812
Name:SAINT XAVIER UNIVERSITY
Entity type:Organization
Organization Name:SAINT XAVIER UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STARESINICH
Authorized Official - Suffix:
Authorized Official - Credentials:MSCCC/SLP
Authorized Official - Phone:708-423-4815
Mailing Address - Street 1:9332 MASSASOIT AVE
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2332
Mailing Address - Country:US
Mailing Address - Phone:708-423-4815
Mailing Address - Fax:
Practice Address - Street 1:9332 MASSASOIT AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2332
Practice Address - Country:US
Practice Address - Phone:708-423-4815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146007369251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)