If you complete the form online, you must print the form and mail it to the address below.
Fees (if applicable) are payable to the "Licensing & Regulatory Affairs".
Licensing & Regulatory AffairsEnvironmental Health SpecialistsPO Box 94986Lincoln, NE 68509-4986
Registered/Provisional Environmental Health Specialist Duplicate/Reissue Form Name Change Form Reinstatement
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