=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497021034
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBECCA L ST. LOUIS DPM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2012
-----------------------------------------------------
Last Update Date | 10/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 225 W WASHINGTON ST STE 1500
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60606-3485
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-504-5000
-----------------------------------------------------
Fax | 847-504-5015
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | W1374 AUBURN ASHFORD DR
-----------------------------------------------------
City | CAMPBELLSPORT
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53010-3204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-205-9214
-----------------------------------------------------
Fax | 847-504-5015
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 998
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 863
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------