Starting a Speech Therapy Private Practice: The First 90 Days in Dependency Order

There are plenty of checklists for starting a speech therapy private practice, and most of them list the same fifteen tasks: form an entity, get insurance, pick an EHR, build a website. What they leave out is the only thing that makes the first 90 days genuinely hard — the order. Several of these tasks block each other, one of them takes months and is entirely outside your control, and doing them in the wrong sequence is how a practice ends up paying rent on a treatment room it cannot legally bill from.

This article sequences the setup by dependency instead of by category. The organizing rule is simple: entity and NPI before credentialing, credentialing before scheduling, scheduling before marketing. Everything else hangs off that spine. Follow the dependencies and the slow steps run in the background while you finish the fast ones; ignore them and the slowest step starts last.

Every setup task falls into one of two groups. Fast tasks are the ones you control: registering an entity, applying for an EIN, applying for an NPI, opening a bank account, buying liability insurance. Each takes somewhere between minutes and a couple of weeks. Slow tasks are the ones other organizations control — and in a therapy practice that means one thing above all: getting credentialed and contracted with insurance payers, which routinely takes months per payer and cannot be meaningfully expedited from your side.

That asymmetry dictates the whole plan. Credentialing applications ask for your entity name, tax ID, NPI, practice address, and liability coverage — so those must exist first, and quickly. And until credentialing resolves, you cannot see in-network patients under those plans — so the weeks of waiting are exactly when you build the scheduling, documentation, and intake machinery you will need on day one. Marketing comes last for the same reason: referrals you cannot schedule or bill are not patients, they are apologies.

The day ranges below are a working plan, not a promise — the fast steps compress easily, and the slow ones stretch. What should not change is the order. Each step exists before the steps that need it.

1. 01

   Days 1–7: Confirm your license covers the practice you are planning

   You need a current SLP license in the state where you will practice — and for telepractice, licensure rules depend on where the client is located, so check each state involved. ASHA notes there is no special additional credential for private practice: state licensure, plus ASHA certification where you hold it, is the clinical foundation. Verify anything ambiguous with your state board now, because every later step assumes this one is settled.

2. 02

   Days 1–14: Form the legal entity and register the business

   Decide the structure with an accountant or attorney — sole proprietorship, LLC, or a professional entity. Many states restrict which entity types licensed professionals may use, so confirm with your secretary of state and licensing board before filing. Your entity name and structure appear on nearly every application that follows, which is why this step cannot trail the paperwork it feeds. Check whether your city or county also requires a local business license.

3. 03

   Days 7–14: Get the EIN, then the NPI — both free

   Apply for an Employer Identification Number directly with the IRS online; it is free and issued immediately during the session. Then apply through NPPES for your NPIs — also free, so never pay a third-party site for either. Note which identifier goes where: your Type 1 (individual) NPI is filed under your personal identifiers — CMS instructs sole proprietors to apply with their SSN, not an EIN, even if they have one. The EIN is what the organization-level paperwork needs: the Type 2 (organization) NPI if your entity will bill under its own name and tax ID, the bank account, and payer applications filed under the entity.

4. 04

   Days 14–21: Open the business bank account and buy liability insurance

   The bank will want the entity documents and EIN — dependency, again. Professional liability coverage should be in force before you treat anyone, and credentialing applications will ask for the certificate and coverage amounts, so buying it now keeps it off the critical path.

5. 05

   Days 14–30: Make the Medicare decision explicitly

   SLPs are not on the list of practitioners permitted to opt out of Medicare. That leaves two honest positions: enroll (via PECOS) so you can treat and bill for Medicare beneficiaries, or decline to provide covered services to Medicare beneficiaries at all. What you cannot do is quietly treat them as cash-pay clients. Decide now, because enrollment is its own multi-week process and shapes which patients you can accept at opening.

6. 06

   Days 21–35: Build the CAQH profile and submit payer applications

   This step is for practices joining commercial panels; a deliberately private-pay-only practice skips it. Most commercial payers pull your credentialing data from the CAQH Provider Data Portal, so complete the profile once, carefully, and authorize the payers you are applying to. Then submit participation applications to your shortlist of payers. This is the step that starts the long clock — every week it slips is a week added to your first in-network visit. Ask each payer for its current expected timeline and track each application like an open invoice.

7. 07

   Days 21–45: Put the HIPAA foundation in place before any PHI exists

   HIPAA applies to covered entities — per HHS, a provider becomes one by electronically conducting standard transactions such as claims or eligibility checks, which describes nearly any practice that bills insurance. For covered practices, the Security Rule requires a documented risk analysis, and any vendor that will create, receive, maintain, or transmit electronic PHI on your behalf must sign a business associate agreement before it touches patient data. A strictly private-pay practice that never conducts those transactions may sit outside HIPAA’s direct reach — but build the same safeguards anyway: state privacy laws still apply, clients expect them, and the moment you submit one electronic claim the obligations are real. Doing this before the first inquiry call means you never retrofit compliance around records that already exist in the wrong places.

8. 08

   Days 30–60: Stand up scheduling, documentation, and billing

   Choose the EHR and practice-management stack while credentialing runs in the background: scheduling with recurring visits, evaluation and session-note templates, superbill or claim workflows, and intake forms. Set your private-pay rates and write your financial and cancellation policies now. The test of this phase is concrete — you could take a referral call today, book the evaluation, collect intake, document the visit, and produce a clean claim or invoice.

9. 09

   Days 45–75: Run a paid pilot on the machinery

   Private-pay and out-of-network clients do not depend on credentialing, so a small early caseload is both revenue and a systems test. Every friction point they hit — intake, reminders, documentation time, invoicing — is a defect report delivered while the caseload is still small enough to fix things calmly.

10. 10

    Days 60–90: Turn on marketing and referral outreach

    Marketing goes last not because it matters least but because its job is to fill machinery that now exists. Announce to your network, meet the pediatricians and specialists you want referrals from, and finish the website with the booking path front and center. As payer contracts finalize, add each plan to your intake screening the day it goes live.

Speech-language pathologists in private practice have only been able to enroll in Medicare and bill it directly since July 1, 2009, when Section 143 of the Medicare Improvements for Patients and Providers Act took effect; before that, SLP services could be paid only when an institution or physician billed them. The right that took an act of Congress to win comes with an obligation that surprises new owners: SLPs are not among the practitioner types federal law permits to opt out of Medicare.

Commercial credentialing has two working parts. The CAQH Provider Data Portal holds your professional data — education, licensure, work history, liability coverage — and the payers you authorize pull from it during their review. Then each payer runs its own credentialing and contracting process on its own timeline. Those timelines vary enough by payer and by state that any specific number would be wrong somewhere, which is exactly why you should ask each payer for its current expected turnaround in writing and calendar a follow-up cadence rather than waiting to be contacted.

Two habits keep this phase from silently stalling. First, treat your CAQH profile as live infrastructure: it must be re-attested on a recurring cycle — every 120 days for most providers — or its status expires and payers pulling your file see stale, unusable data. Second, keep a one-page tracker with a row per payer: date submitted, confirmation number, last contact, next follow-up date. A credentialing application nobody follows up on is functionally an application that was never sent.

While the clock runs, the waiting weeks are productive by design: they are when the scheduling, documentation, billing, and intake systems from the day 30–60 phase get built and tested. If your state and situation allow it, private-pay and out-of-network clients — with superbills they can submit to their own plans — are a legitimate early caseload that does not depend on any payer’s timeline. The Medicare rule above is the exception to keep in view.

A dependency plan is as much about what not to do early. A long office lease can wait — many practices start with a sublet room, home office for telepractice, or hourly clinic space, and sign the lease once the caseload proves the location. Branding beyond a clean one-page website can wait; a parent choosing between practices books with the one that answered the phone, not the one with the better logo. Paid advertising can wait until your referral loop and booking path demonstrably work, because ads amplify whatever process exists — including a broken one. And hiring waits until your own schedule is full enough that turning referrals away costs more than a salary.

The 90-day sequence ends at a gate, not a date. Book the first visit when every item below is true — and if one is false, the checklist tells you exactly which dependency to go finish.