Name change (PDF)
- Will be made only when a copy of an official document (marriage certificate, divorce decree or court order) is submitted with a letter of request. The fee for a duplicate license is $5.00 (check or money order) payable to the Commonwealth of PA.
Address change (PDF) - Written requests should include the old address, new address and license number and/or social security number. The Board must be notified within 10 days of any change in address.
Verification of licensure to another state - request ONLINE *
* Notification Regarding Online LOGS Requests (PDF)