The secretary may grant a provisional license to a person who has met all of the requirements for obtaining a license except for the successful completion of an examination. A provisional license must be renewed annually. The secretary may grant a provisional license to a person up to four times. A provisional license holder may only practice genetic counseling under the supervision of either a licensed genetic counselor, a physician licensed under chapter 18.71 RCW, or osteopathic physician licensed under chapter 18.57 RCW, with a current certification in clinical genetics issued by an organization approved by the secretary.