- If you require a certificate of verification to go to another jurisdiction(s), please submit separate verification request forms with applicable fees for each verification requested.
- The Online Change of Address feature allows you to change your address of record listed in our database. To use this function, you must provide certain information for authorization.
Change of Name or Request for Duplicate License for Board of Speech-Language Pathologists and AudiologistsThis PDF form maybe used to request a name change, address change or a duplicate license.
- Note: The Health Care Fraud Application is for use by insurance companies and fraud agencies.