R9-16-507. Changes Affecting a License or a Licensee

A. A licensee shall submit a change application to the Department in a Department-provided format, within 30 calendar days after the effective date of a change in: 1. The licensee’s home address or email address, including the new home address or email address; 2. The licensee’s name, including one of the following with the licensee’s new name: a. Marriage certificate, b. Divorce decree, or c. Other legal document establishing the licensee’s new name; 3. The place or places, including address or addresses, where the licensee engages in the practice of speech-language pathology; or 4. A licensee’s supervising speech-language pathologist, including an attestation completed and signed by the supervising speech-language pathologist with the name and license number of the supervising speech-language pathologist that meets the requirements according to A.R.S. § 36-1940.04(E), (F), and (G). B. A licensee may obtain a duplicate license updating the information requested in subsection (A) by submitting to the Department a change application in a Department-provided format that contains: 1. The licensee’s name and address, 2. The licensee’s license number and expiration date, 3. The licensee’s signature and date of signature, and 4. The fee specified in R9-16-508.