Individual
KELLY TYLER COONEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
1027 E BURNSIDE ST, PORTLAND, OR 97214-1328
(503) 239-8400
(503) 239-8406
Mailing address
1027 E BURNSIDE ST, PORTLAND, OR 97214-1328
(503) 239-8400
(503) 239-8406
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
08/18/2025
Last updated
08/18/2025
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