MEDICARE: JILLISA SPOTTISWOOD

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	1041C0700X	Clinical Social Worker	P023350	NC

General Provider Information

NPI Number	:	1417806977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILLISA SPOTTISWOOD

Provider Business Mailing Address
First Line	:	432 MOULTONBORO AVE
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-5529
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	319 CHAPANOKE RD STE 120
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27603-3433
Country	:	US
Telephone Number	:	657-348-9160
Fax Number	:

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

Provider Enumeration Date	:	01/27/2026
Last Update Date	:	01/27/2026

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Directions to “ JILLISA SPOTTISWOOD ” Practice Location

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