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How can I change my name or address?

Name changes must be submitted in writing by downloading the Data Change/Duplicate License Request Form. Address changes can be submitted online at or in writing by downloading the Data Change/Duplicate License Request Form. Fax it to 517-373-2179 or mail it to the Department of Licensing and Regulatory Affairs, Bureau of Health Care Services, Health Professions Division, PO Box 30670, Lansing, MI 48909.

New licenses are not automatically issued for name and/or address changes. To receive a license with your new name and/or address, you must submit $10.00 per license with your request. Duplicate licenses can be paid for online at

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