Speech-Language Pathologist/Audiologist Name Change

Instructions:

You must mail, fax, or email following information:

  • copy of your marriage certificate or court order (required),
  • your MN SLP/Aud license number,
  • current address, and
  • telephone number.

If you email us, there must be a PDF scanned copy of the marriage certificate or court order attached to your email.

Processing time takes 5-15 business days. You will be notified in writing of the change as well as receiving a wallet card with your new name.

Fax number:

651-201-3839

Email:

Health.SLPA@state.mn.us

Mailing Address:

Minnesota Department of Health
Health Occupations Program
Attn: Gloria Rudolph
PO Box 64882
St. Paul, MN 55164-0882

Updated Wednesday, February 12, 2014 at 02:05PM