Provider Demographics
NPI:1023210242
Name:BEAN, TRACI MICHELLE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:MICHELLE
Last Name:BEAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6941 ENRIGHT DR
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95621-2836
Mailing Address - Country:US
Mailing Address - Phone:916-214-2326
Mailing Address - Fax:
Practice Address - Street 1:5525 DEWEY DR
Practice Address - Street 2:SUITE 106D
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-3129
Practice Address - Country:US
Practice Address - Phone:916-214-2326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13057235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist