Request a Name Change for a Licensee
Division of Acute Disease Prevention, Emergency Response, and Environmental Health (ADPER & EH)
Within this Division we regulate and license individuals and business in 16 different program areas. Please click a link on the left to find more information related to your specific license.
To request a name change for an individual who holds a license(s) with one of the programs listed on the left, please complete the following form and submit it to the Help Desk:
ADPER & EH Regulatory Programs Name Change Request Application
A name change request can take between 24-72 hours to complete; you can verify the change has occurred online. Note: updated copies of active licenses will be sent automatically via email once the request has been processed.
Addresses, phone numbers, and emails can be updated by logging in to the Regulatory Programs Licensing Portal.
For more information about name change requests, please contact the Regulatory Programs Help Desk at 855-824-4357 or email firstname.lastname@example.org.