Change your Contact, Address, Name or Personal Status Information

We must have your current mailing address in our system. This is especially important because we mail your courtesy renewal notice and updated credential to the address on file. The U.S. Postal Service doesn't forward Department of Health mail so it is your responsibility to inform the Customer Service Office of an address change.

For health professions ONLY

We must have your current mailing address in our system. This is especially important because we mail your courtesy renewal notice and updated credential to the address on file. The U.S. Postal Service doesn't forward Department of Health mail so it's your responsibility to inform the Customer Service Office of an address change.

If your contact information isn't current in our system, please complete and submit the contact information change form.

Contact our staff members if you have any questions.

After completing the form submit it to the Department of Health by:

  • Email – select the "Email" button on the contact information change form, it'll be sent automatically.
  • Fax – to 360-236-4818
  • Mail – to the address at the bottom of the form

For allopathic physicians and physician assistants ONLY: Contact Information Change Form

For EMS providers ONLY

The Personal Status Change Application provides the process for updating an EMS certification record when a person's name, address or agency changes. Changes can be made on the paper application or through the Online Renewal process.

Note: Application forms provided can no longer be filled out on the computer and printed. Please print out the form, complete the application and obtain the required signatures.

Steps:

Step 1: Complete the Personal Status Change Application (PDF)
This form MUST be printed out to complete and to obtain the necessary signatures.

Step 2: Provide the information to this office

Please return all applications to:

Department of Health
Customer Service Office
P.O. Box 47877
Olympia, WA 98504-7877

If you have questions regarding EMS certification, please call Customer Service at 360-236-4700

For allopathic physicians and physician assistants ONLY

Contact Information Change

For ARNPs, RNs, LPNs, and nursing technicians ONLY

You may use these instructions to update your contact information online.

For medical marijuana consultants ONLY

Contact/Address Change

To change my name on my credential ONLY

Please mail, email, or fax a copy of your certified marriage certificate, divorce decree or court order showing your name change to the Customer Service Office. You won't be sent a credential showing your new name until your next renewal has been processed. You may also include this request when submitting your renewal by mail or in person. If you plan on renewing online, we must have your current name in our system prior to renewal. We'll print your renewed credential with the name we have on file at the time of renewal.

For chiropractors and chiropractor x-ray technicians ONLY

Contact information change form

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