NPIMap

Organization Active NPI

Antonia Jensen & Associates, LLC

Doing business as aja Behavioral

  • Clinical Social Worker
  • Wauseon, OH
National Provider Identifier
1093772733
Registry record updated Jul 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
I-7226 Issued in OH
Legal business name
ANTONIA JENSEN & ASSOCIATES, LLC
Doing business as
aja Behavioral
Practice address
1115-1 N Shoop Ave
Wauseon, OH 43567-1857
Phone
(419) 335-6122
Fax
(419) 318-4157
NPI assigned
Apr 27, 2006
Last updated
Jul 17, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Antonia Gracia Grimolizzi-Jensen, LISW-S, ACSW, MSSANPI 1962577510
Title
Owner
Phone
(419) 335-6122

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X I-7226 OH
Mental Health Counselor 101YM0800X I-7226 OH
Professional Counselor 101YP2500X I-7226 OH
Clinical Social Worker 1041C0700X I-7226 OH Primary

Addresses

Primary practice location

1115-1 N Shoop Ave
Wauseon, OH 43567-1857

Mailing address

P.O. Box 146
Wauseon, OH 43567-0146
Phone (419) 335-6122

Other identifiers 3

IdentifierTypeStateIssuer
716572000OtherOHMAGELLAN HEALTH SERVICES
000000371817OtherOHANTHEM BC & BS
282524354005OtherOHMEDICAL MUTUAL

Other names 1

  • aja Behavioral Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040805001661 OH Part B Supplier - Clinic/Group Practice 0042281537 Receives reassigned benefits from 2 practitioners
Practice locations: Lima, OH; Napoleon, OH; Wauseon, OH; Defiance, OH

National Provider Directory

National Provider Directory

Locations

516 E High St
Ste Ac
Bryan, OH 43506

3478 W Elm St
Lima, OH 45807
Phone (419) 335-6122

1000 Westmoreland Ave
Napoleon, OH 43545
Phone (567) 264-4007

1000 Westmoreland Ave
Ste B
Napoleon, OH 43545

1115 N Shoop Ave
Wauseon, OH 43567
Phone (419) 335-6122

1115 N Shoop Ave
Ste 1
Wauseon, OH 43567
Phone (419) 335-6122

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689552000000",
    "number": "1093772733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 146",
            "city": "WAUSEON",
            "state": "OH",
            "postal_code": "435670146",
            "telephone_number": "419-335-6122",
            "fax_number": "419-318-4157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115-1 N SHOOP AVE",
            "city": "WAUSEON",
            "state": "OH",
            "postal_code": "435671857",
            "telephone_number": "419-335-6122",
            "fax_number": "419-318-4157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTONIA JENSEN & ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-27",
        "last_updated": "2023-07-17",
        "certification_date": "2023-07-17",
        "status": "A",
        "authorized_official_last_name": "GRIMOLIZZI-JENSEN",
        "authorized_official_first_name": "ANTONIA",
        "authorized_official_middle_name": "GRACIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "419-335-6122",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LISW-S, ACSW, MSSA"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "I-7226",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "I-7226",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OH",
            "license": "I-7226",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I-7226",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN HEALTH SERVICES",
            "identifier": "716572000",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC & BS",
            "identifier": "000000371817",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL MUTUAL",
            "identifier": "282524354005",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "aja Behavioral",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wauseon, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.