Healthcare Provider Details

I. General information

NPI: 1578598462
Provider Name (Legal Business Name): J. PRESTON HARLEY PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3155 BOOK RD SUITE 103
NAPERVILLE IL
60564-9545
US

IV. Provider business mailing address

PO BOX 492
WHEATON IL
60189-0492
US

V. Phone/Fax

Practice location:
  • Phone: 630-293-4321
  • Fax: 630-293-4297
Mailing address:
  • Phone: 630-293-4321
  • Fax: 630-293-4297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number071-004240
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071-004240
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number071-004240
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: