MEDICARE: LELAH GADISON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1619828456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LELAH GADISON

Provider Business Mailing Address
First Line	:	12135 FORT LEATON
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78254-6357
Country	:	US
Telephone Number	:	210-388-3693
Fax Number	:	210-388-3693

Provider Business Practice Location Address
First Line	:	21727 W INTERSTATE 10 STE 108
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78257-2108
Country	:	US
Telephone Number	:	956-786-0162
Fax Number	:	956-786-0162

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2026
Last Update Date	:	02/06/2026

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Directions to “ LELAH GADISON ” Practice Location

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