Healthcare Provider Details

I. General information

NPI: 1619891801
Provider Name (Legal Business Name): COCREATION COMMUNICATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
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

784 S CLEARWATER LOOP # 4344
POST FALLS ID
83854-9599
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 State

VIII. Authorized Official

Name: MS. ANNIKA ELIZABETH ROE
Title or Position: SOLE MEMBER
Credential: M.S.,CCC-SLP
Phone: 208-999-8798