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General NPI Number Information
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NPI Number | 1396605564
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Entity Type | Organization
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Legal Business Name | SALT AND LIGHT EQUITY LLC
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Dates
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Enumeration Date | 11/12/2025
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Last Update Date | 11/12/2025
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Provider Practice Location Address
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Address Line | 14111 DOUGLAS PKWY STE 102
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City | URBANDALE
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State | IA
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Zip | 50323-2197
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Country | US
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Telephone | 515-779-9981
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Fax |
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Provider Business Mailing Address
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Address Line | 3615 148TH ST
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City | URBANDALE
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State | IA
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Zip | 50323-2069
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Country | US
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Telephone | 515-779-9981
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CLINTON ELLIS
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Credential |
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Telephone | 515-779-9981
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number |
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License Number State |
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