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Indiana Professional Licensing Agency

PLA > Professions > Board of Podiatric Medicine > Name Change Information Name Change Information

How to ChangeYour Name

If you have a legal name change and wish to change the name on your license, you will need to submit official documentation to verify the change.  This documentation includes a marriage license/certificate, social security card, or divorce decree.  The request for name change must be made in writing (including a copy of the official documentation) to our office by faxing 317.233.4236, e-mail to mailto:pla3@pla.IN.gov, or by mailing 402 West Washington Street, Indianapolis, Indiana, 46204.  Your name change request must include your license number and how you want your name to read on your license. 

To receive an updated license with your changed name, please verify that the name change has been completed by our office at http://www.in.gov/pla/license.htm.  Once it has been updated, you may print a free pocket card or purchase one to be mailed to you.  There is a $10 fee to purchase a new pocket card.

If the name change is simply due to a typographical error made by the Board's office, please e-mail mailto:pla3@pla.IN.gov to notify us of the error.  You will need to include your license number and how your name should read on your license.