Provider Demographics
NPI:1952652331
Name:SHAPINSKY, ALICIA CROSSLAND (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:CROSSLAND
Last Name:SHAPINSKY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 S 6TH STREET RD
Mailing Address - Street 2:SUITE 1700
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-5771
Mailing Address - Country:US
Mailing Address - Phone:217-525-8332
Mailing Address - Fax:
Practice Address - Street 1:2921 GREENBRIAR DR STE B1
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-6440
Practice Address - Country:US
Practice Address - Phone:217-546-3118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2018-03-17
Deactivation Date:2015-09-02
Deactivation Code:
Reactivation Date:2016-10-21
Provider Licenses
StateLicense IDTaxonomies
IL071.007940103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical