Healthcare Provider Details

I. General information

NPI: 1932019841
Provider Name (Legal Business Name): GEMMA LOUISE SLACK DAPPEDPSYCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17409 BRIDGE HILL CT
TAMPA FL
33647-3467
US

IV. Provider business mailing address

4545 SCARLET LOOP
WESLEY CHAPEL FL
33544-7378
US

V. Phone/Fax

Practice location:
  • Phone: 813-447-1736
  • Fax:
Mailing address:
  • Phone: 813-447-1736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number13355
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: