How healthcare licensing works in the U.S.

Licensed, certified or registered: what's the difference?

• Licensed means the state gives you legal permission to practice, usually after an approved education program and an exam. Registered nurses, LPN/LVNs, dental hygienists, physical therapists, occupational therapists and speech-language pathologists are licensed in every state. Respiratory therapists are licensed in every state except Alaska, which passed a law in 2026 to start licensing them.
• Certified or registered often means you've completed training and an exam and are listed by the state. Nurse aides are the clearest example: after passing the competency exam they're placed on the state registry, and they must be on it to work in a nursing home.
• Not state-regulated (or only partly): Most states don't require medical assistants to be certified, and entry-level dental assistants usually don't need a state license, though states that allow expanded duties do require one.

Why it's state by state

Professional licensing is a state power. Each state passes a practice act for each profession and creates a board (or a department) to enforce it. That's why requirements, fees and renewal rules differ, and why moving states means getting licensed again unless a compact applies.

Who issues what

• Boards of nursing license RNs and LPN/LVNs. A few states have a separate board for practical or vocational nurses, such as California's Board of Vocational Nursing and Psychiatric Technicians.
• Nurse aide registries are usually run by the state health department, sometimes by the board of nursing.
• Dental boards license hygienists and regulate dental assistants. A few states have a separate dental hygiene board or committee.
• Medical boards or separate boards regulate respiratory therapists in many states.
• Therapy boards license PTs, OTs and SLPs, sometimes in a combined board.

Every state's official authorities are listed, with links, on the state licensing pages.

Practicing in more than one state

Interstate compacts let you practice in other member states with one license. There are compacts for nurses, physical therapists, occupational therapists, and audiologists and speech-language pathologists. How compacts work.

Keeping your license

Most licenses must be renewed every one or two years, often with continuing education. Keep your address current with your board, and keep your CE certificates in case you're audited.