Healthcare Provider Details

I. General information

NPI: 1689112070
Provider Name (Legal Business Name): KRISTINE ELIZABETH SONSTROM MALOWSKI AU.D., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 900
GROTON CT
06349-5900
US

IV. Provider business mailing address

9 BARBERS RD
NORWICH CT
06360-9468
US

V. Phone/Fax

Practice location:
  • Phone: 860-694-2550
  • Fax:
Mailing address:
  • Phone: 860-402-4396
  • Fax: 330-972-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number17.000726
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: