Healthcare Provider Details

I. General information

NPI: 1275245300
Provider Name (Legal Business Name): ABIGAIL RYAN NEWMAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ABIGAIL RYAN BILDERBACK

II. Dates (important events)

Enumeration Date: 12/20/2022
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W OAK ST
CARBONDALE IL
62901-1400
US

IV. Provider business mailing address

PO BOX 19639
SPRINGFIELD IL
62794-9639
US

V. Phone/Fax

Practice location:
  • Phone: 618-536-6621
  • Fax: 618-453-1102
Mailing address:
  • Phone: 217-545-8000
  • Fax: 217-545-2101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.008877
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: