Active NPI
Brooke Pistilli
- Speech-Language Pathologist
- Fairfax, VA
National Provider Identifier
1043624646
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 2202007075
- Practice address
- 12563 Summit Manor Dr Apt 415
Fairfax, VA 22033-5755 - Phone
- (610) 207-9771
- NPI assigned
- Jun 12, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 2202007075 | VA | Primary |
Addresses
Primary practice location
12563 Summit Manor Dr Apt 415
Fairfax, VA 22033-5755
Mailing address
12563 Summit Manor Dr Apt 415
Fairfax, VA 22033-5755
Phone (610) 207-9771
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2202007075 | VA | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Excel Growth Therapies, LLC | Speech-Language Pathologist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Developmentally Disabled Services Day Training Agency
- Fredericksburg, VA
- NPI 1073788931
Speech-Language Pathologist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1402531200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1787875200000",
"number": "1043624646",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12563 SUMMIT MANOR DR APT 415",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220335755",
"telephone_number": "610-207-9771"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12563 SUMMIT MANOR DR APT 415",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220335755",
"telephone_number": "610-207-9771"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PISTILLI",
"first_name": "BROOKE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-06-12",
"last_updated": "2026-08-28",
"certification_date": "2026-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "VA",
"license": "2202007075",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfax, VA
- Pinnacle Family Practice, LLC
- Maureen Piotrowski
- Catherine M Pipan, M.D.
- Samia Piracha, M.D.
- Anna Piskorski, M.D.
- Maria Alicia Pitarque Heishman
- Olivia Marie Planas, AU.D.
- Planned Parenthood of Metropolitan Washington DC
- Planned Parenthood of Metropolitan Washington DC
- Plastic Surgery and Dermatology Associates, LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.