Healthcare Provider Details

I. General information

NPI: 1598590077
Provider Name (Legal Business Name): ANNIKA ELIZABETH ROE MS.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5697 W OLD RANCH ST
GARDEN CITY ID
83714-1839
US

IV. Provider business mailing address

5697 W OLD RANCH ST
GARDEN CITY ID
83714-1839
US

V. Phone/Fax

Practice location:
  • Phone: 208-999-8798
  • Fax:
Mailing address:
  • Phone: 208-999-8798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: