Kelly Tyler Cooney – Contractor in Portland, OR

Key facts

NPI: 1588541007
Entity type: Individual (NPI type 1)
Primary specialty: Contractor 171W00000X
Practice address: 1027 E Burnside St
Portland, OR 97214-1328
Phone: (503) 239-8400
Fax: (503) 239-8406
NPI assigned: Aug 18, 2025
Sex: Unspecified or another gender identity
Sole proprietor: No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Coda, Inc. Substance Abuse Rehabilitation Facility · Portland, OR · NPI 1437213865

NPD
Coda, Inc. Substance Use Disorder Rehabilitation Clinic/Center · Seaside, OR · NPI 1750912184

NPD

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

Practice roles

Organization	Specialty	Status	New patients
Coda, Inc.		Current since Aug 25, 2025	Accepting new patients
Coda, Inc.		Current since Aug 25, 2025	Accepting new patients

Locations

1027 E Burnside St
Portland, OR 97214

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Contractor	171W00000X			Yes

Addresses

Primary practice location

1027 E Burnside St
Portland, OR 97214-1328

Mailing address

1027 E Burnside St
Portland, OR 97214-1328
Phone (503) 239-8400

Other providers in Portland, OR

All providers in Portland, OR · Contractor in Oregon

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 18, 2025. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.