From Three Jobs to Thirteen Providers: Julia Mari on Building a Bilingual Therapy Practice from Scratch
Julia Mari was working three jobs, seeing 65 patients across all of them, squeezing families into 30-minute sessions because there simply weren't enough hours in the week. She was working Monday through Sunday. And she wasn't getting paid well.
"I didn't like for the parents to drive to the clinic just for 30 minutes. So I started thinking, what could I do to fix that?"
That question led her to open Greenville Bilingual Therapy in February 2018. A year and a half later, she has 13 providers, a sensory gym, a full kitchen for feeding therapy, and a waiting list that started forming four months after she opened. Her story is one of the fastest growth trajectories we've heard on Clinic Chats, and it started with a Sunday afternoon filling out Medicaid applications.
Love Brought Her to South Carolina, Grit Built the Practice
Julia's path to private practice didn't follow a straight line. She was completing her clinical practicum in Puerto Rico when she fell in love and moved to South Carolina in 2002. That meant finishing her hours while flying back and forth to Puerto Rico every other weekend. Then she spent six months in Nicaragua doing clinical work through EBS with Hortensia Kaiser, a well-known expert in serving the Hispanic population, all unpaid, purely for the experience.
When she returned to South Carolina, she jumped into three simultaneous positions. The caseload across all three grew to 65 patients. The early interventionists she worked with saw what was happening and started pushing her.
"Julia, I think you can do it on your own. You have so many patients already."
She listened. On a Sunday afternoon, she started filling out the applications for Medicaid and the early intervention system in South Carolina. There was a catch: her husband was also launching his own business at the same time, which meant Julia's salary was the only stable income in the household. It was a real risk. But the relationships she'd built with early intervention providers meant referrals followed her from day one. She didn't have to visit a single pediatrician's office. By June 2018, four months after opening, she already had a waiting list.
Thirteen Providers in Eighteen Months
The growth numbers are striking. Julia started solo. Within a year and a half, she had 13 providers working under her, eight doing home-based therapy and the rest working out of the clinic. The engine behind that growth was her relationship with her alma mater in Puerto Rico.
Over three years, she brought eight students from Puerto Rico to Greenville for clinical practicums. Six of those students graduated, moved to South Carolina, and joined her team. She also added occupational therapists and was in the process of bringing on physical therapists by January.
Julia trimmed her own caseload to 25 patients so she could focus on admin, supervision, and all the things she didn't go to school for. She's candid about that learning curve.
"I don't see myself doing anything else."
Her husband's experience opening his car shop two years earlier turned out to be a hidden advantage. Julia had already been through the licensing, permits, and legal requirements once. The second time around felt familiar. And because she openly admits that SLPs "are not good with numbers," her husband handles the bookkeeping, payroll, and tax filings. It's a partnership that works.
A Clinic Built Around Bilingual Feeding Therapy
The physical space Julia built reflects her clinical priorities. The clinic has five treatment rooms, a playground area with a sensory gym, a full kitchen with mirrors and long tables for feeding therapy, and an observation room where parents can watch sessions. Nearly all of her feeding patients are on the autism spectrum, so the clinical model pairs sensory work with feeding therapy in a single visit.
Home-based providers have their own supply cabinets at the clinic. Every Monday, the entire team comes in for case discussions and to prep materials for the week. Home-based providers earn five dollars more per session to account for drive time, since the Hispanic population in the area is often 25 minutes or more from the clinic. Some providers work as few as 10 hours a week while holding school-system jobs. Others work 45 hours.
Julia keeps the team connected with monthly get-togethers. She takes them out to eat, gives them space to vent about tough cases, and works to keep morale high. They're independent contractors, so she doesn't provide benefits, but the flexibility works for providers at different stages of life.
Fighting for Fair Reimbursement on Medicaid
The financial picture isn't all smooth. Julia's practice is 99% Medicaid, and two of her contracted health insurance plans only reimburse at 80%. She can't bill the remaining 20% to families because the Medicaid contract prohibits it.
"The population that I serve, they are low income. No matter what, they are not going to be able to pay anything. And I'm happy to serve them. So that's why I'm here."
She's not just absorbing the loss quietly, though. Julia is part of a Facebook group of South Carolina SLP practice owners who are collectively lobbying for better reimbursement rates. They draft a single email, collect signatures from over 100 providers, and submit it together. It's a slow fight of phone calls, emails, and waiting, but they're organized about it.
The EMR system is her biggest operational expense outside of payroll and rent. She pays about $1,000 a month for 13 providers. Her $2,500 monthly rent was a shock initially, but she hasn't found a space she likes better. Testing materials are another significant cost. Because the practice is bilingual, she needs Spanish and English versions of every standardized assessment. She estimates the full inventory runs around $5,000. She offsets some of that by working on Pearson research projects like the GFTA and PLS-5 Spanish/English editions, which earn her 10-15% discounts on materials.
She has two admin staff: one intake coordinator who manages referrals, scheduling, and provider calendars, and one person dedicated to billing, authorizations, and insurance denials.
Don't Get Scared. Do It.
Julia's advice is direct. Open your practice. The learning goes far beyond clinical work, into finance, admin, advocacy, and leadership. She wouldn't trade any of it.
At the time of recording, she was six months pregnant with her first child. She sees the flexibility of practice ownership as exactly what she needs for this next chapter. She can shift her caseload to other providers, handle admin from home, and step back without shutting anything down.
"If I have to do it again, I will do it again a million times."
From three jobs and 30-minute sessions to a 13-provider bilingual practice with a sensory gym and a feeding kitchen, Julia Mari built something remarkable in Greenville. And she built it by following referrals, investing in relationships, and refusing to let fear make the decision.
Scaling a practice from one provider to thirteen means your systems have to keep up. ClinicNote is a HIPAA-compliant EMR built specifically for private practices and university clinics, handling documentation, scheduling, and billing in one place so you can focus on the families you're there to serve. See how ClinicNote works.
Transcript
Kadie: You are listening to Clinic Chats, the speech therapist's private practice podcast. A podcast full of personal journeys where we not only talk about success stories, but also real life struggles of small business startups. Clinic Chats is sponsored by ClinicNote, a HIPAA compliant cloud-based EMR platform used specifically by private practice owners and university clinics. I'm your host, Kadie Jackstat, and thank you for joining me today.
Kadie: I'm joined by the owner of Greenville Bilingual Therapy, Julia Mari. Thank you so much for joining me. How are you today, Julia?
Julia: I am doing good. We're getting ready for the fall weather, so I am happy about it.
Kadie: I agree. Some people might not agree with us, but I feel the exact same. Bring it on.
Julia: Oh, yeah. For me that I do home base, I was melting back in August and September. It was really bad. So I'm happy.
Kadie: So hopefully a long fall and not too brutal of a winter.
Julia: You're right.
Kadie: All righty. Well, I can't wait to learn about your private practice. I was looking at your website and I found that this might be a second career path. Is that correct?
Julia: That is right. Yeah. I moved here to South Carolina back in 2002. So by then I was doing my clinical practicum in Puerto Rico. And when I moved here, I started doing my clinical practicum here and in Puerto Rico. So I was traveling every other weekend to Puerto Rico.
Kadie: Oh, my goodness. It's insane.
Julia: Yeah. But I fell in love with my husband now. So that's what love called. So I didn't have any other option. So I completed my hours here and I had the opportunity to go to Nicaragua for six months with EBS. I don't know if you know that company.
Kadie: Yeah.
Julia: So I did my clinical practicum there with Hortensia Kaiser. She's like a guru with the Hispanic population. So she works for EBS and she has a PhD. So I didn't want to miss that opportunity at all. So I spent six months there in Nicaragua working for EBS, not getting paid, but just the experience was enough for me.
Julia: And then I came back here and I started working as a speech pathologist for three companies. And it was insane because I was working Monday through Sunday, having a waiting list. I had to see patients for 30 minutes because I didn't have enough time to see them all. And that's how I ended up thinking about opening my practice.
Julia: I didn't like for the parents to drive to the clinic just for 30 minutes. So I started thinking, what could I do to fix that? And I started looking for information about Medicaid, early intervention system here in South Carolina. And on Sunday afternoon, I started filling out all the applications and that's how it worked out. It wasn't easy at all. And I was so scared because my husband was opening his own business at the same time. So my salary was the only one that was safe in the house environment.
Kadie: So it was quite a risk to kind of shake the steady income up a little bit.
Julia: Exactly. But yeah, I mean, it was scary, but it worked out perfectly. By the time that I opened the clinic, I was working for two other jobs at the same time. So it helped a little bit because I had like two part times into private practices. And I was doing my own patients on Fridays and Saturdays and Sundays sometimes.
Kadie: Wow.
Julia: Yeah, it was hard, but I didn't have kids by then. I had the time because my husband was busy working on his business. So I didn't have to be at home. It was hard, but I don't regret at all. Like if I have to do it again, I will do it again a million times.
Kadie: Yes. So how did you take the first steps of marketing that you were going to start coming and seeing patients on your own?
Julia: Since I was working for two other companies, I had this relationship with the early interventionists already. And they were the ones who pushed me to open my practice. They were like, Julia, I think you can do it on your own. You have so many patients already. I got to the point when I had sixty five patients in my case in between the three jobs. That's too many. And I wasn't getting paid that well. So I was like, yeah, let me look about the pay rate through Medicaid and early intervention. And since I knew the early interventionist already, it was pretty easy to market the private practice. So they know that I was opening my practice already. And once I transitioned my whole caseload to my practice, they followed me like they were sending me referrals all the time. I didn't have to go to any pediatricians to do marketing. That was amazing.
Julia: So I did use Instagram and Facebook a little bit, but it got to the point when I opened the clinic in February 2018 and by June I had a waiting list already. So it was amazing. It was great.
Kadie: So you've been open about a year and a half now, totally independent.
Julia: Yes.
Kadie: Wow. And how many days a week are you working and what does your schedule look like now as far as caseload numbers?
Julia: Well, I started one and a half year ago just by myself. Now I have 13 providers working for me.
Kadie: What?
Julia: Yes. It was insane. Since I have this relationship with my university in Puerto Rico, I started getting students from Puerto Rico to do the clinical practicum here. So the last three years I have had eight students doing clinical practicum here in Greenville, South Carolina. And from those eight students, I have six that they are working with me already. They graduated, they moved from Puerto Rico to here and they are so happy. And now I have OTs and we're in the process of getting PTs by January. So I'm so excited.
Kadie: How amazing.
Julia: Right now I only have 25 patients in my caseload. That way I can do admin and supervision and all the things that I didn't go to college to, but I've been learning in the process. So, yeah, it's a challenge. But yeah, I love it. I don't see myself doing anything else.
Kadie: No, with that kind of success in only a year and a half, can you imagine where the next year and a half could take you?
Julia: Yeah, it's amazing. And I have to tell you, like, I think because my husband opened the business, he has a car shop, but he opened the business two years before I opened my practice. That helped me a lot because I knew where did I have to go to get the license or the permits to open the clinic. So it was like doing everything for the second time because I did everything with my husband for the first business.
Kadie: Even though it wasn't in the therapy setting, at least you saw all the business, you know, legalities.
Julia: Yes. So that helped me a lot in the process. And of course, you know that SLPs, they are not good with numbers because I hate numbers. But my husband is really good with the bookkeeping, so he's helping me with the payrolls and all the taxes every three months. So it's kind of smooth because I have him. If I have to do it by myself, it could be another story.
Kadie: This is just such a cool story. So are all of your providers now, do they also do home based? Do you go to all the clients? No brick and mortar practice?
Julia: In between. I have 13 providers right now and eight of them, they are doing home based. The others, they usually work at the clinic because we do a lot of feeding.
Kadie: So you do have an actual office location.
Julia: Yeah, we do have an office. I have a playground area with a sensory gym that I've been building for the last six months because we have a lot of patients in the spectrum. Pretty much all the patients that I have that we work on feeding, they are in the spectrum. So that way we can do the sensory part first and then we can do the feeding part in the kitchen area. So we have a huge kitchen area with mirrors and like long tables and like an observation room for the parents to see the session. And we have the sensory area.
Julia: So we do home based, but for those feeding patients, we try to get those patients to the clinic. That way we can work on both areas at the same time.
Kadie: So some clinicians are home based and some clinicians are in the clinic. And then how many actual treatment rooms are within that clinic as well?
Julia: We got five treatment rooms right now. It's right next to my husband's office. So I have my husband next to me all the time, which is amazing because if I need something like bookkeeping or tax information, I have him there for help.
Kadie: You can hop right over. That is great. Can you run us through some of the expenses that you have had to take on in the initial month starting up the practice and then the month to month costs that you have found?
Julia: Of course, the first one was the rent. I wasn't expecting to spend twenty five hundred dollars in rent, but I have the space that I want and I've been looking for other spaces like bigger spaces for the future, just in case we keep growing. But the one that I have right now, it's perfect. Like I haven't found one that I would say this one, it's the best one to replace the one that I have.
Julia: So rent was a big challenge for me the first few months. Other than that, I would say the EMR system, I was kind of picky looking for a good one. And I don't know if you have heard about Fusion.
Kadie: I have.
Julia: Yeah, they are from here, actually. So I used to work with the owner from Fusion. His wife is an OT and we used to work together. So we work in the pilot Fusion program and I love the system. So I know that if I wanted a good EMR system, I have to pay good money.
Kadie: What kind of expense is that for 13 providers?
Julia: So right now we pay almost a thousand dollars monthly for the EMR system.
Kadie: Wow.
Julia: Yeah, but we don't need anything else. We have everything there. We don't have to pay for like a fax website on the side. Everything is included in the same EMR system. So I cannot complain at all. I pay the thousand dollars, but I'm happy with it.
Kadie: And in between that and, of course, the payroll, because you have a different pay rate for home base and for clinic base, since your husband is the one who works on that, is he the one who kind of keeps things in check?
Julia: He's the one who tells me, like, you have to go slow this month buying toys or buying therapy material because we spend that much money on payroll or rent or whatever. So he's the one who controls me, actually, because I'm a shopaholic buying toys for the clinic.
Kadie: Well, that just shows that you care and you want to provide kids with exciting things, but you've got to have your husband too to kind of keep things on track financially, I suppose.
Julia: That is true. And the other thing that was kind of challenging for me was the testing material. But I found out that if you work for Pearson doing the projects, sometimes you can get a discount. So I started doing that. So I work on the GFTA project, the PLS-5 for Spanish and English population. They give you like a 10 or 15 percent discount sometimes. So that was a good deal for me when I opened the clinic because you need to have all kind of material. Plus, we are bilingual. So that means that I need to have Spanish and English testing material.
Kadie: So how many different standardized tests do you have at this point?
Julia: Pretty much all of the ones that Pearson sells for Spanish population, like the PLS, the GFTA, English and Spanish. For both of them, we have the CELF, we have the OWLS. We have the CELF in Spanish and English. I just bought the BESA, which is a new testing material from I think it's a linguist system for Spanish and English population as well. And right now we are working on the CELF preschool project that is coming out next year.
Kadie: They add up quickly. So it is an expense to invest in good standardized tests.
Julia: Yeah, you can spend up to like five thousand dollars in testing material if you want to have everything updated.
Kadie: I'm sure starting off, it was kind of a hit financially or expense wise. But now that things are month to month, you have a consistent caseload for all of your therapists. Are the finances kind of evening out as far as income expenses?
Julia: Yeah, we cannot complain at all. Definitely. After we pay the payroll and we pay the expenses, we can say that we are happy with the product, definitely. And that's the money that I keep using to keep growing. Like we buy new material, now that we have the sensory room. We are always buying like new swings or new slides for the kids. So I keep updating material at the clinic as far as we can get outcomes financially.
Kadie: And you continue to pay yourself, I hope, too, for the treatment and hours that you spend.
Julia: Yeah, we do. We do have a transfer from the clinical account to my personal account every month. But I don't see that money. We usually like if we have to use that money for other stuff at the clinic, we will.
Kadie: And do you do all of the intake calls and scheduling with clients calling and getting them in line with their therapist?
Julia: We have two admin staff right now. There is one that is the intake coordinator. She is the one who receives the referrals. She calls the early interventionist. She calls the pediatricians and she calls the parents. And then she's the one who looks for the providers schedules to see which one has an opening. So she does all about calendar and scheduling with the providers and the patients.
Julia: And then I have another admin staff that works on billing and authorizations, all the crazy stuff that I really don't want to deal with. But I have to sometimes. She's the one who is in charge of the denials with the health insurance. She collects everything from the health insurance and she is on top of everything about billing with Medicaid and Medicare.
Kadie: So you take quite a few insurances, I suppose.
Julia: Yeah. Right now we are taking pretty much all kind of Medicaid HMOs here in South Carolina. We have the private insurance like Blue Choice or United Health Care. So, yeah, pretty much all of them. But I would say that the population that we serve right now, they are 99 percent Medicaid right now.
Kadie: And do you have any issues with reimbursement rates as far as particular insurances that might not pay well or for the most part, are you happy?
Julia: No, actually, that's my fight every month. There are changes pretty much every month. So we have to go through that pretty much every month as well. So we got two health insurance that don't pay 100 percent of the services. They only pay 80 percent. So we are losing 20 percent, but we cannot charge that to the parents because they have Medicaid, right? And that's on the contract. So we cannot charge anything to the parents. So we are losing 20 percent.
Julia: But you know what? The population that I serve, they are low income. No matter what, they are not going to be able to pay anything. And I'm happy to serve them. So that's why I'm here. So I'm going to keep doing it no matter what.
Kadie: If you can make ends meet, you know, if the numbers at least work out to be able to pay your employees, then it can make sense.
Julia: Yes, definitely. But health insurance, like I don't know if in Iowa you have like Molina or First Choice. Those are the insurance that we are fighting with the government right now to see if we can get better reimbursements.
Kadie: Well, that's good that you're taking the time to do that. And you'll have to let us know if it works, because I'm sure others would be interested in hearing.
Julia: It's a lot of callings and calling the right people and just wait for them to respond to you, emails. Here in South Carolina, we have a Facebook page for all the SLPs that own private practices. So what we are doing right now is we get a loan and we try to send just one email and we sign that email in between all the providers. So that way they know that it's not just one provider fighting for these. It's like more than 100 providers trying to get the right rate for the service.
Kadie: Absolutely. And are your providers hired on as employees or are they independent contractors?
Julia: They are contractors.
Kadie: So you don't have to provide benefits, which is less expense for you. You mentioned there is a different rate for home based. Is that due to kind of thinking of drive time and wear and tear on vehicles?
Julia: Yeah, because the Hispanic population here in South Carolina, it's kind of far from where we live. It's like 25 minutes and it's not fair to not pay a little bit more to the providers because they need to drive to here and everything. So, yeah, I do pay. It's like five dollars more per service if they do home based.
Kadie: Do they have access if they're doing home based? Can they come to the clinic and get any toys or materials if they need to utilize them in their sessions?
Julia: Yes, they do have their own cabinet. So on Mondays we don't do home based. On Mondays is the only day that I have my all my team at the clinic. So that way we can discuss cases, we can get toys from the cabinets to go ready for sessions on Tuesday morning, that way they can get ready for the week.
Kadie: It sounds like it's a pretty close team. Do you have any minimum hour requirements or as independent contractors, do some work very part time where others have a full caseload?
Julia: Yeah, I do have a few providers that they only work like 10 hours because they are working full time for a school system and they come just in the afternoons to see a few patients. Or I have providers that are working 45 hours a week because they don't have kids, they live with their parents still because they are young and they just want to make money. So, yeah, I have the two opposites.
Kadie: Well, it's a balance and it's nice that they all have opportunities to what works for them at this point in their life.
Julia: That's true. But it's an amazing team. I try to keep them happy and every month we go on get togethers and I take them to eat and everything that way we can get along. And if we have frustrations with any kind of cases that we see at the clinic or home base, we can ventilate.
Kadie: Absolutely. Well, I just am amazed at how things are running so smoothly. The success in only a year and a half. Like I said, how great and kudos to you.
Julia: Yeah, it's good. We always have those challenge days when we get frustrated for denials from Medicaid or when we cannot make it work for the families in between scheduling, or we cannot take those families to the clinic because some of our families don't drive. So we do have some of those frustrated days. We always make it work. That's definitely worth it in the long run.
Kadie: As far as words of advice for anyone who wants to jump into private practice, do you have anything that you wanted to share?
Julia: I do. Don't get scared and do it. Open it. It's amazing. It's an amazing journey. And you learn so much. Like I said, we went to school to be a speech pathologist. But when you open your own practice, you learn about admin, you learn about financial stuff, you learn about how to fight for the things that you want or how to use the money in the right way.
Julia: So it's just amazing. Right now I'm pregnant. I'm almost six months pregnant.
Kadie: Oh, congratulations.
Julia: And this is the first baby. So I would say that learning all the things that I have learned in these two years, I'm ready to grow this baby. I'm going to try to transfer all these things to my baby. So it's just awesome.
Kadie: How rewarding. That's an amazing thing. And what a great motivation to have your future child be able to see their mom being so successful.
Julia: Yeah. And this is one of the good things about having a private practice, you have the flexibility. You can be flexible about your schedule. And I'm thinking about, of course, I'm going to work in the admin area, but I can transfer my patients to another provider. That way I can have time to grow this baby.
Kadie: You can find time for the admin stuff on your own time at home while baby's asleep or whatever it may be. And take a little step back for a little while while you raise your family.
Julia: That's my plan. So I am so happy about having the practice at this right moment. Definitely.
Kadie: No more three jobs, seven days a week. I mean, it was worth it because that's why you have what you have right now, but it was hard. So not anymore.
Julia: Not anymore.
Kadie: Well, I thank you so much for your time. And I wish you the best as the practice continues to grow.
Julia: Thank you so much, Miss Kadie. And congratulations on the baby.
Kadie: Thank you. Thank you for joining me and listening to Clinic Chats, the speech therapist's private practice podcast. If you have a moment, please leave a five star review for Clinic Chats to help other SLPs find our podcast. If you'd like to share your own personal journey through private practice, please email me. Kadie at ClinicNote.com. That's K-A-I-D-E at ClinicNote.com.