Provider Demographics
NPI:1265228910
Name:BIBINS, TRACI (CCHW)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:BIBINS
Suffix:
Gender:
Credentials:CCHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 VILLA DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-3508
Mailing Address - Country:US
Mailing Address - Phone:734-717-7942
Mailing Address - Fax:734-217-4482
Practice Address - Street 1:1110 W CROSS ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-2105
Practice Address - Country:US
Practice Address - Phone:734-217-4441
Practice Address - Fax:734-217-4482
Is Sole Proprietor?:No
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker