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For your convenience, you may download the Request for Changes to an Individual License (PDF) to report a name change, address change or to request a duplicate license.

Rules and regulations - A hard copy is available from the Board office upon request.  Remember to include your mailing address with your request.

Name Change - 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. A corrected license will only be sent if requested and paid for.
 
Address Change - 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. The fee for a duplicate license is $5.00 (check or money order) payable to the Commonwealth of PA. A corrected license will only be sent if requested and paid for.
Note:    As a result of document fraud and in an effort to protect its licensees, the Board will only provide direct source verification of your license to another state licensing agency.