Starting an SLP Private Practice: The Setup Checklist

Starting a private practice is mostly an administrative project attached to clinical work you already know how to do. The clinicians who succeed aren't better therapists — they're the ones who set up billing, contracts, and referral flow before they see client number one.

Before you see a client

• License in good standing in every state where clients are physically located — including teletherapy clients. Check the state requirements directory.
• Business entity — sole proprietorship or LLC; some states restrict professional entities, so confirm locally.
• EIN, business bank account, and bookkeeping separate from personal finances from day one.
• Professional liability insurance, plus general liability if you have a physical space.
• HIPAA-compliant EMR with a signed business associate agreement, and secure email or portal messaging.
• Consent, financial policy, and no-show forms written before you need them.

Private pay vs. insurance

Private pay is faster to launch: set a rate, collect at time of service, provide a superbill for out-of-network reimbursement. Insurance brings volume but adds credentialing — 60 to 120 days per payer — plus authorizations, claim denials, and contracted rates you can't set yourself. Many practices start private pay, add one or two payers once the schedule is stable, and never contract with the lowest payers.

Setting your rate

Work backwards from a target take-home. Billable hours realistically top out around 20 to 25 a week once documentation, marketing, and admin are counted. Add self-employment tax, health insurance, retirement, EMR, materials, and unpaid time off. The hourly rate that yields your target is usually well above what a staff job pays per hour — that gap is the cost of running the business, not profit.

Referrals in the first six months

• Pediatricians and ENTs in a five-mile radius, with a one-page sheet on what you treat and how fast you can schedule.
• Local school SLPs, who field parent requests for private services they can't provide.
• Neurology and outpatient rehab for adult caseloads.
• A simple website with a page per service and per city you serve, and a working contact form.
• Parent groups, preschools, and early intervention coordinators.

Teletherapy expands your radius

A telepractice component lets you serve rural areas and fill gaps between in-person clients, subject to licensure where the client sits. See the teletherapy guide for platform, consent, and cross-state considerations, and the interstate compact overview for multi-state practice.

Common first-year mistakes

• Undercharging, then having no room to absorb no-shows.
• Signing every insurance contract offered, including the worst rates.
• No written cancellation policy.
• Mixing personal and business money.
• Skipping quarterly estimated taxes.