Change Of Address And/Or Name

(1) Change of Address - Each person holding a certification who has had a change of home address, shall file in writing with the board his/her current address, giving both old and new addresses. Such request shall be received in the board’s administrative office no later than thirty (30) days after such change is effective and must reference the individual’s name, profession, and certificate number. (2) Change of Business Address - Each person holding certification who has had a change of employment or clinic affiliation shall file in writing with the board his/her current address, giving both old and new addresses. Such notices shall be received in the board’s administrative office no later than thirty (30) days after such change is effective and must reference the individual’s name, profession, and certificate number and the name and license number of the new employer. (3) Change of Name - An individual registered with the board shall notify the board in writing within thirty (30) days of the name change and will provide both the old and new names. A request for name change must also reference the individual’s profession, board, and certificate number.