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Name/Address Change

All licensees must update any change of name, public, mailing, business address, telephone number(s) and email addresses. Licensees can update their information online by U.S. mail, or by fax.


  • You can change your name/address online through your online account. If you do not have an online account, you can register using your license number, social security number, and date of birth. 
  • Follow the link to access your Online Account

Paper Form: 

Note: When changing your name, please attach a copy of your name change document (marriage certificate, court document, etc.) with the name/address change forms submitted to the Board office via email, fax, or U.S. mail. 

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