Name of the Organization : Washington State Department of Health
Type of Facility : Change your Contact, Address, Name or Personal Status Information
Country : United States of America
Website : http://www.doh.wa.gov/LicensesPermitsandCertificates/ProfessionsNewReneworUpdate/ChangeyourContactorAddressInformation
Contact Information Change Form : https://fortress.wa.gov/doh/opinio/s?s=CICF
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.
Related : Washington State Department of Health Court Ordered Name Change on a Birth Certificate USA : www.statusin.org/23964.html
** 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: Contact/Address Change
** 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.
** We cannot accept contact information updates over the phone.
** If your contact information isn’t current in our system, please complete and submit the contact information change form.
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 EMS providers ONLY: Personal Status Change
** 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 assistance filling out this form, please contact the Medical Commission Credentialing Unit at 360-236-2750.
** For faster service, press ‘Email’ to electronically submit this form to the Medical Commission.
** Or the completed form can be printed and mailed or faxed to
Mail to :
Washington State Medical Commission
Credentialing Unit
P.O. Box 47866
Olympia WA 98504-7866
Fax: 360-236-2795
For medical marijuana consultants ONLY: Contact/Address Change
** 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.
** We cannot accept contact information updates over the phone.
** 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
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.