Speech-Language Pathologists Application For Licensure
Audiologists Application For Licensure
Speech-Language Pathology Assistant and Audiology Assistant Application For Licensure
Observation Log for Applicants for Speech-Language Pathology Assistant and/or Audiology Assistant
Reinstatement of Lapsed/Expired License Application
Verification Request
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.-
Online Address Change for Speech-Language Pathologists and Audiologists
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 Audiologists
This PDF form maybe used to request a name change, address change or a duplicate license. Division of Professional Licensure Complaint Form
Health Care Fraud Complaint Application
Note: The Health Care Fraud Application is for use by insurance companies and fraud agencies.
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