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State of Nevada Speech-Language Pathology, Audiology & Hearing Aid Dispensing Board

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Initial License Application

Initial License Application

Applicant Information

Please complete the information below. Your name should be entered how it is to appear on your license.


First Name	Middle Name	Last Name	Suffix
Social Security Number / Taxpayer Identification Number		Date of Birth	Gender
Other Names you have used		Place of Birth

Contact Information


Mailing Address
City	State	ZIP Code
Contact Phone Number	Alternate / Cell Phone	E-mail Address

Page Updated: 10/12/2022 11:38:38 AM

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NV Speech-Language Pathology, Audiology & Hearing Aid Dispensing Board
6170 Mae Anne Avenue, Suite 1
Reno, NV 89523
Phone: 775-787-3421
Fax: 775-746-4105
Email: Contact Form

Hours: M-F: 9:00am - 4:00pm Pacific

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