Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 071-004240 | IL |
N | 103TC0700X | Clinical Psychologist | 071-004240 | IL |
N | 103G00000X | Clinical Psychologist | 071-004240 | IL |
N | 103TC0700X | Clinical Psychologist | 071-004240 | IL |
N | 103TR0400X | Rehabilitation Psychologist | 071-004240 | IL |
NPI | 1578598462 |
---|---|
Provider Name | Dr. J. Preston Harley |
First Address | Wheaton, IL 60189-0492 |
Second Address | Naperville, IL 60564-9545 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R78420 | (02) | IL |