Provider Demographics
NPI:1093209322
Name:EGNATUK, SARAH COCO (BCBA, LBA)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:COCO
Last Name:EGNATUK
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-7216
Mailing Address - Country:US
Mailing Address - Phone:512-705-7091
Mailing Address - Fax:
Practice Address - Street 1:2016 OAK PARK BLVD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7828
Practice Address - Country:US
Practice Address - Phone:337-429-5248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL-296103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst