From Maternity Leave to Multiple Therapy Rooms: Alexandria Zachos on Growing a Specialized SLP Practice

Most SLPs don't start a business because they have a baby who sleeps well. But Alexandria Zachos will tell you, with a laugh, that her daughter's napping habits had everything to do with Social Butterfly, Inc. getting off the ground. What started as a handful of evening home visits during maternity leave has grown into a multi-room private practice in the Chicagoland area, with three other speech pathologists on staff and a reputation for treating some of the most underserved areas of social communication.

Her story isn't about a grand plan. It's about building something real, one good decision at a time, while raising two kids and refusing to settle for being a generalist.

Building a Caseload on Opposite Schedules

Alexandria spent nine years as a school-based SLP before taking maternity leave, and she used nearly all of that time to dabble. PRN inpatient work. Outpatient therapy. Private clients during summer breaks. So when she decided to explore private practice full-time, she wasn't starting from zero. She had clinical range and a growing sense of what she actually wanted to treat.

The logistics, though, required creativity. Her husband worked a traditional nine-to-five. When he came home, Alexandria headed out to see clients in their homes, evenings and Saturdays. That tag-team arrangement kept the family afloat while the caseload grew.

About a year and a half in, she knew it was time for a physical space. Chicagoland winters and the stress of driving house to house made that decision easy. She found a single room off Craigslist, rented from a counselor, and every one of her existing clients was willing to make the switch.

"I was worried about asking my clients to start coming to a physical space, but all of them were very willing to do so."

From there, the growth was steady. One room became a larger suite across the hall. That became the current location, with multiple therapy rooms and a team.

Finding the Niche That Found Her

One of the things Alexandria loves most about owning a practice is the freedom to specialize. In the schools, she felt pressure to be a generalist, ready for whoever walked through the door. Private practice gave her permission to go deep.

Social communication was the first love, and it's right there in the name. She built Social Butterfly around kids on the autism spectrum and children who struggled with friendships and peer interaction. But two other specialties emerged organically.

She started seeing adults who stutter, a population she finds deeply rewarding. And then, almost by accident, she stumbled into treating delayed echolalia. Parents kept calling about kids on the spectrum who were saying things that seemed out of context. Alexandria started researching and discovered Marge Blanc's Natural Language Acquisition framework, a treatment approach for breaking down delayed echolalia and moving children toward self-generated language.

"Marge's work really spoke to me. I devoured her book pretty quickly and looked at her online courses and then reached out and contacted her."

That deep dive led to co-presenting with Marge Blanc at ASHA in Los Angeles in 2017, and again with colleagues in Boston the following year. Alexandria has since traveled to school districts and clinics across Illinois sharing what she's learned. Her next goal is creating parent-friendly materials, because so much of the echolalia work happens at home through modeling.

The Insurance Reality (Even With Just One Payer)

Alexandria accepts one insurance company: Blue Cross Blue Shield. You might think that simplifies things. It doesn't, not as much as you'd hope.

Plans within the same insurer vary wildly. Deductibles, copay amounts, developmental exclusion clauses. Her team uses an online verification system and asks families to call and check their own coverage before the evaluation starts. Both sides check so nobody gets surprised.

"I always tell new clients that same exact thing. I really like both of us to check so that everyone's in the know about what's going on."

She's learned the hard way about diagnosis code issues and families who hear "you have speech therapy coverage" without realizing they have a $5,000 deductible to meet first. Now she warns every new family upfront. And she has a part-time contractor who handles the especially difficult insurance calls, about five hours a week of someone willing to sit on hold with Blue Cross so Alexandria doesn't have to.

That kind of delegation is small but meaningful. Insurance is, by her own admission, one of the biggest downsides of private practice ownership.

The Real Cost of Flexibility

Ask Alexandria about the hardest part of being a practice owner, and she doesn't talk about marketing or insurance first. She talks about time.

Her whole reason for going into private practice was flexibility, being there for her kids while doing work she loved. But for years, that flexibility looked like writing reports during nap time, answering emails at midnight, and squeezing progress notes into whatever pockets she could find while also being a stay-at-home mom.

"I would be trying to write a report during nap time, or I'd stay up really late till midnight one night answering emails, dealing with insurance things, or writing progress notes."

She's open about this because she knows other SLP moms are living the same thing. And she wants them to hear that it does get easier. This year, for the first time, she's shifting toward exclusively daytime hours. Her other employees cover after-school slots. She drops off and picks up her kids every day, something she couldn't do at a traditional job.

Last year, she was in the clinic from 9 a.m. to 9 p.m. on Wednesdays. She doesn't recommend it. But she did it because the practice needed it at that stage. Now the business is big enough to support the life she was building toward all along.

Vacation Isn't Optional (It Just Requires Data)

Alexandria and her family just returned from 15 days in Greece when this episode was recorded. That kind of break doesn't happen by accident in private practice.

Her approach is practical. She tracks attendance patterns and noticed that families tend to take vacations in late July and August. So she plans her own time off for those same windows. Pediatric clients, especially the long-term ones, actually benefit from a week or two of rest before a transition like the start of school.

"I don't think clients get upset with a break. I think a lot of these pediatric clients, especially that we're seeing long term, it's kind of nice for them to have a week or two off."

She doesn't get as many breaks as a school-based SLP. But she gets something else: the ability to design her own schedule around what matters.

Progress That Feels Like the Point

When asked about her greatest success, Alexandria doesn't point to revenue milestones or office expansions. She talks about seeing progress with clients in the areas she chose to specialize in.

In the schools, her caseload shifted every year. Meetings consumed her time. She rarely got to follow a client long enough to see real change. Now she treats the kids and adults she wants to treat, in the way she believes works, and she watches them grow.

"I feel like right now, I actually am where I need to be. And I'm seeing the type of progress that I kind of always hoped to see back even when I was in grad school and dreaming about being an SLP."

That's the payoff. Not the space or the staff, though those matter. It's the clinical work itself, finally matching the vision she had from the beginning.

Growing a practice means juggling documentation, insurance, and scheduling on top of the clinical work you actually care about. ClinicNote is a cloud-based EMR built for private practices and university clinics, keeping your notes, billing, and scheduling in one place so you can focus on the clients who need you. 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. Today I'm speaking with Alexandria Zachos, the owner of Social Butterfly, Inc., and this is episode six. Hi, Alexandria. How are you?

Alexandria: Hi. I'm great. Thanks for having me.

Kadie: Yeah. Welcome to the Clinic Chats podcast. I'm so excited to get to learn a little bit about your private practice and the overall journey of getting to where you are today. So maybe we could start out with a little background of becoming an SLP and the journey to starting a private practice.

Alexandria: Sure. I'm going into my 16th year as an SLP, and I have been in private practice for a little over seven years. I was previously employed full-time by a local school district, and I worked for them for about nine years, but during that time I did a bunch of other things. So I worked PRN, inpatient, doing swallow studies at a local hospital. I also did outpatient therapy for a while, worked in a private clinic also for a little while, and then I always had my summers off working at the school, so I also had some private clients on the side during the summertime. So when I was expecting my first daughter, I decided to take a year maternity leave from my school position and explore growing my private practice, and that's kind of how everything got started.

Kadie: Was it kind of a slow start while you were juggling new momhood and deciding to take that route?

Alexandria: So I joke around about this, and I actually told my daughter that I was going to say this on the podcast, but I told her that my business would not have gotten started if she wasn't such a good baby. She just was one of those babies that was a great sleeper from the beginning and pretty odd for a new mom, but I did feel like I had time on my hands, that I could actually get things accomplished. That was not the case with my second daughter at all. But yes, I felt like I had a great napper and a great sleeper, and I built my website, and slowly I just started building up a caseload.

Kadie: Yes, that is so lucky that you had such a good little baby to also start a business at that crazy time. Did you see clients in your home or start off renting a space?

Alexandria: So I actually started off in their homes. I did not feel like I wanted to deal with finding a space until I had built up a solid caseload. And the first year, my husband and I actually did opposite schedules. So he went to a traditional nine-to-five job, and then he would come home and be with our daughter, and I would go to clients' homes and service them in the evening, and then also on Saturdays. And then probably about a year and a half into that, I decided I needed a space, and I no longer wanted to go into homes. So being in the Chicagoland area, winters here are pretty tough, and it was getting really stressful driving around to different houses and trying to get everywhere on time.

Kadie: So then you rented your own space, and where did it go from there?

Alexandria: Yeah, so I actually found a space off of Craigslist from a counselor that was renting out offices in a bigger suite to other professionals. And so I just rented out one room from her, and I was worried about asking my clients to start coming to a physical space, but all of them were very willing to do so. And so just from there, things started growing, and I think once I got credentialed by Blue Cross Blue Shield, which is still the only insurance company that I accept, I was able to start getting clients through them. And at some point, things there just got really busy, and I felt like I wanted to go somewhere larger where I had the ability to also hire someone else and just have multiple therapy rooms. So first, I moved into a larger space across the hall from where I was, and then eventually here to my current space. And I now have multiple therapy rooms, and I do employ three other speech pathologists.

Kadie: Are they employees or contractors? How does that work for you?

Alexandria: Sure. So two of them are employees, and one of them is a contractor. The contractor that I have is a very experienced speech pathologist who has her own company, and actually her background is she moved around quite a bit because of her husband's job. And so she actually reached out to me when she moved to Chicago because she wanted to work in a clinic that focused on social communication, which is her niche area. And so she actually works for me a couple days a week and then works at some other places as well during the week. So she kind of has her own little niche.

Kadie: And then what about you? Have you found your specialty, and what do you advertise as that?

Alexandria: Sure. Yeah. So that's actually probably the part that I love the most about being in private practice. I felt that when I worked for the school district that I kind of had to be a generalist because working in the schools, you just never know what's going to walk through your door. But that is the place that I really became passionate about social communication, and that's actually how my clinic got its name, Social Butterfly. I really wanted to work with either kids on the autism spectrum or just kids in general that were having difficulty socializing and making friendships. So that's one area, but since then, I've also really developed a love for working with adults that stutter.

So I do still see a handful of adult clients, and my third area actually just kind of happened in the past three to four years. I started getting a lot of calls from parents about kids on the autism spectrum that were having difficulty socializing with peers because they were saying things that the parents felt were out of context. Well, come to find out, these children were communicating with delayed echolalia, and I just started digging into it and doing a lot of research, and I came across Marge Blanc's work. She has an approach she calls natural language acquisition, which is a treatment framework for breaking down delayed echolalia and helping move the child to self-generated language.

And Marge's work really spoke to me. I devoured her book pretty quickly and looked at her online courses and then reached out and contacted her. So long story short, Marge and I ended up presenting together at ASHA in Los Angeles in 2017, and then I presented again with some other colleagues of hers in Boston in 2018. And treating delayed echolalia has really become a passion of mine, and I've also gone around to different school districts and clinics in Illinois presenting about it.

Kadie: How cool is that? All of your specialties, really, but especially the delayed echolalia piece. It sounds like something new and something that, honestly, I haven't heard the latest research on myself. That is very, very cool. Are you going to be returning to ASHA this year?

Alexandria: This year, I'm not going to be going. We decided not to do a talk this year. I would really love to start focusing on creating some parent-friendly materials because, really, what this approach is is a certain type of modeling. So you can help the child break down their echolalic utterances, and I feel like a lot of that work is done at home. So I'm doing a lot of parent training here at my clinic, but I do feel like I would love to educate more parents out there on how they can help their own child at home.

Kadie: Exactly. Kind of branch into a resource that could be sold and spread beyond your local area.

Alexandria: Yeah, that would be great.

Kadie: Over the course of your private practice lifespan, have you been doing any certain documentation system? Are you loving something right now? What has been working for you?

Alexandria: So that has also definitely evolved over the years as we've grown. I was using paper for taking notes, and I had a physical file for everyone when I first got started. And I just used Availity, which was the free system online to bill Blue Cross. But then that got to be really too much, and there's a reason that it's free. It takes a while to use. So I started researching different EMRs, and right now I'm currently using an EMR called Therapy Notes. It's actually made for, it was developed for psychologists, I believe.

Kadie: Oh, okay.

Alexandria: But it actually works really well for speech language pathologists, and I'm able to integrate my credit card system in there. Everything's kind of all in one place, and everything's cloud-based, which I really love. I was telling you earlier that I was having some computer issues. I'm actually on a borrowed computer laptop right now, and it's really nice because I don't feel like there's anything on my other laptop that I actually need, since everything is cloud-based.

Kadie: Yeah, absolutely. It's great that you found something that works well for you. Clinic Chats podcast is actually sponsored by an EMR system, ClinicNote, but we are so open to hearing about what's working for everyone, and we're happy that you found something that is working super great for your practice. As far as accounting goes, do you keep all of that yourself, or is that work that you've hired out?

Alexandria: So I think eventually I'm definitely going to get to the point where I will need to hire out. I'm doing a lot of these things on my own right now. I actually use QuickBooks. We have an accountant, so everything gets put into there. And then, really, I get just assistance maybe five hours a week from an independent contractor who does office work for actually quite a few little offices around here in our office complex, and she helps me with really difficult insurance issues. So she will stay on the phone with Blue Cross or get the necessary paperwork uploaded or faxed. But other than that, I'm pretty much taking care of everything on my own through just my EMR and QuickBooks.

Kadie: Well, it's awesome that you have those two systems in place. And really nice that you have kind of a little assistant, like you said, because I doubt you want to be sitting on the phone for hours at times with insurance companies.

Alexandria: No, for sure. I would say that's probably one of the biggest downsides to private practice. When I talk to other private practitioners, really just the time suck that is insurance. It takes up so much time. So unless there's someone else to do that, it's really down to the owner trying to carve out time in his or her day to get that taken care of.

Kadie: Absolutely. Yes. Do you call all of your clients' insurances before they start with you or because you just work with one insurance? Has it been fairly simple?

Alexandria: I would love if it was even more simple, but unfortunately, there are so many differences between plans, even though it is just one insurance company. So we actually do both things. So we don't call. We have an online system that we use to check unless, for example, you can't get the information on there, then a phone call does need to be placed. But then we also ask that new clients call themselves and check on their coverage. That way they know what's going on and we know what's going on. We were both reported the same information prior to the evaluation. So they're aware of any large deductibles and copay amounts.

Kadie: That's good to check and make sure everyone's on the same page, right?

Alexandria: Yes. Yeah. And I always tell new clients when they call that same exact thing. I say, I really like both of us to check so that everyone's in the know about what's going on. One of, I think, the biggest things that people don't realize when they call, they'll say, oh, we have speech and language coverage. I called and they said that we do. But then I come to find out that they have like a $5,000 deductible. So they don't realize they will be paying all of that money out of pocket before Blue Cross actually pays for their services. And if people have utilized their insurance for that, they're unaware.

Kadie: Yeah. And have you ever ran into the issue where someone's told that they get coverage or, oh, you've met your deductible and then you run into a diagnosis code issue?

Alexandria: Yes, that has definitely happened to us before. And so now that's another thing that I warn people about. So I say, you know, certain plans will have a clause that says if it's not, if it's developmental, rather, it's not covered. So I do tell parents to look into that. Obviously, for my adult clients, because they are all adults that stutter, I'm able to tell them what I think that the diagnosis code would be beforehand. And so they specifically are able to ask about that.

Kadie: Yeah, that's very nice. I wanted to ask about taking time off, because in my blog this week, I'm talking about how challenging it can be to reward yourself with time off when you're self-employed. So how have you navigated that? And do you carve out time for yourself?

Alexandria: Yeah, that is such a good question. Actually, my family and I just got back from a 15-day vacation in Greece.

Kadie: That sounds amazing.

Alexandria: It was wonderful. We came back about a week ago now. But that is such a good question, because that is something I very much struggled with when I thought about never going back to the schools and being self-employed. I think a really helpful thing is, once you're in business for a while, to look at your attendance patterns. And we do offer special social communication groups every summer. And that has been since the beginning. And what I tried to see when I was offering those groups was when people would be out on vacation. So I started noticing a pattern in the past few years that people tended to take their vacation in late July or August, or at least wanted time off in August before school started.

So this summer, when we were planning our vacation, I knew that I wanted to take those couple of weeks in August. And it also aligns with the time my husband's able to take off of his job. So it ended up working out really well. But I think you just kind of have to plan for it. And I don't think clients get upset with a break. I think a lot of these pediatric clients, especially that we're seeing long term, it's kind of nice for them to have a week or two off or just have some time before another major change happens, like school starting.

I think obviously Christmas holidays are another good time to take a small vacation, and a lot of people want time off then. So I've definitely made it work. I don't think I have as many breaks as someone working for the public schools, but I also have the benefit and flexibility of making my own schedule. So I will say right now that I'm able to drop off and pick up my kids from school pretty much every single day, things that wouldn't happen if I was at another typical either school-based or nine-to-five job.

Kadie: Definitely. And at this point in your career, is your day finished once you are picking up your own kids? Or do you go back and see more clients still in the evenings ever?

Alexandria: So every year my schedule has looked different since the day that I started this practice. And this year, I'm actually in my first year of slowly starting to move my schedule to exclusively daytime hours. Like last year, for example, I was here on Wednesdays from almost 9 a.m. to 9 p.m., which I would not recommend. And the day was very full, very, very full with clients. I was trying to accommodate after-school clients. At this point this year, I still am working on Saturday mornings and seeing some after-school clients. But my goal, as my daughters are both in school full-time, would be that I'm really just working during their school day. This is kind of the year I'm moving in that direction. And I have my other employees that are able to cover those after-school hours. I'm really excited about it and this new phase and moving in this daytime direction.

Kadie: Yeah. So can you, looking back, I'm sure it might be hard to pinpoint something specifically, but what has been, in all honesty, one of the biggest struggles of being a private practice owner?

Alexandria: Honestly, the first thing that popped into my head when you said that is multitasking and finding time for things. I think that my biggest drive in going into private practice, well, two things, really. One was being able to specialize in an area that I love to treat. But the second was flexibility. And I wanted to be there for my kids and I wanted to spend the most amount of time I could with them when they were babies. And even more so now that they're going to be in school all day, I want to be there for the after-school hours.

So the biggest, biggest hurdle for me has been putting work in during whatever pockets of time I can find. And I think for all moms out there, it's pretty difficult when your kids are young to find those pockets of time when you're home with them. So I would be trying to write a report during nap time, or I'd stay up really late till midnight one night answering emails, dealing with insurance things, or writing progress notes. I am excited to finally be in a place now where all of that can hopefully get accomplished during a work day. But before, I was juggling pretty much working and being a stay-at-home mom. It was very hard to find time to do everything.

Kadie: Oh, my goodness. So hard. And like you said, it's not like you're just leaving from that 5 p.m. to 8 p.m. time slot and doing therapy. There's the therapy planning and the documenting and evaluation reports. It's not like you just come and go and that's it. There's so much more to be done. And you're squeezing it in a nap time.

Alexandria: That's right. Yes, that's so true. Again, I think there's a lot of SLPs out there in a similar position. So I like to just kind of cheer them on and let them know, like, you can eventually move in this direction, but it is really tricky when you're trying to do all the things and your kids are small.

Kadie: Yeah, I'm sure it is such a game changer once they are in school. Not that you're wishing time away because they're only little for so long, but.

Alexandria: Right.

Kadie: Well, that is definitely a really good point. And as far as your greatest success, what do you think looking back was a moment of, aha, this is amazing. It's so worth it. Has there been that moment for you?

Alexandria: I feel like I've had a lot of those moments. But for me, it mainly happens when I see progress with my clients. And I just feel so good about the areas that I love treating. And then I'm actually able to see the kids I want to see or the adults I want to see and actually see progress with them. I think that was not something I truly felt when I worked in the schools because my caseload was always changing. Year to year, things would be different. I spent so much time in IEP meetings and other types of meetings. I feel like right now, I actually am where I need to be. And I'm seeing the type of progress that I kind of always hoped to see back even when I was in grad school and dreaming about being an SLP.

Kadie: That is awesome. Well, for those that want to find you, you are active on social media. Is that right? Facebook, Instagram?

Alexandria: Yeah. I do have to say I don't use my Facebook and Instagram all that often, but I'm definitely there. So it's SBSpeechTherapy on Instagram. And just my website, too, is sbspeechtherapy.com.

Kadie: I really appreciate you joining me today. It's always great to hear everyone's success stories. And it definitely seems like you have your own that so many will find motivating and encouraging.

Alexandria: Thank you. Thank you so much for having me.

Kadie: 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 kadie at clinicnote.com. That's K-A-I-D-E at clinicnote.com.