This form is not intended for establishments such as salons, barbershops, schools or funeral homes. If you have an address change for your establishment, the administrative rules state "A change in location or site of an establishment shall require submission of an application for a new license and payment of the fee." This application can be found under the Application Process page.
To help us identify new information, please check the box next to any item that has changed.
Address or name changes can also be mailed to the following address:
Iowa Department of Public HealthBureau of Professional LicensureLucas State Office Building, 5th floor321 E. 12th StreetDes Moines, IA 50319-0075
Please include your full name, date-of-birth, license number, and full address in all correspondence.
This form may not be used for address changes of non-U.S. residents. Mail your address change to the address above.
Fields marked with an * are required.
You may add a message for the Bureau of Professional Licensure in the text area below. No more than 1,000 characters may be sent in the message.
Barb Huey, Bureau Chief | Lucas State Office Building | 321 E. 12th Street, Des Moines, IA 50319 | (515) 281-0254
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