A licensee authorized to practice under this chapter shall notify the board of a change of mailing address or name not later than 30 days after the change. A report of a change of name must be made in writing and must be accompanied by one of the following to verify the change of name:

1. (1) a completed affidavit supplied by the board;
2. (2) a certified copy of a marriage certificate;
3. (3) a certified copy of a divorce decree; or
4. (4) a certified copy of a court ruling.

(Eff. 1/13/80, Register 73; am 12/1/84, Register 91; am 12/27/2012, Register 204)