Healthcare Provider Details

I. General information

NPI: 1417801804
Provider Name (Legal Business Name): AISTE SOLLY M.A., M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2026
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 ALCATRAZ AVE
BERKELEY CA
94702-2605
US

IV. Provider business mailing address

1311 ALCATRAZ AVE
BERKELEY CA
94702-2605
US

V. Phone/Fax

Practice location:
  • Phone: 510-290-2980
  • Fax:
Mailing address:
  • Phone: 510-290-2980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number36642
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: