MEDICARE: BROOKE ALEXANDRA SPEIDEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator		MD

General Provider Information

NPI Number	:	1740113026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE ALEXANDRA SPEIDEL

Provider Business Mailing Address
First Line	:	702 PINE ST
Second Line	:
City	:	LA PLATA
State	:	MD
Zip	:	20646-9304
Country	:	US
Telephone Number	:	304-643-7211
Fax Number	:

Provider Business Practice Location Address
First Line	:	5211 AUTH RD STE 203
Second Line	:
City	:	SUITLAND
State	:	MD
Zip	:	20746-4339
Country	:	US
Telephone Number	:	202-257-6632
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2026
Last Update Date	:	06/05/2026

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Directions to “ BROOKE ALEXANDRA SPEIDEL ” Practice Location

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