From Paperwork to Patients: Teresa Harp on Building a Niche Practice Around Hearing Loss
Teresa Harp filed her LLC paperwork two full years before she saw her first client. That might sound like procrastination, but it was actually a calculated move. By handling the legal setup in 2013, she cleared the runway so that when life was ready in 2015, she could start seeing families at Sound Speech in New Jersey without waiting on bureaucratic delays.
Her practice serves a very specific population: children who are deaf and hard of hearing. It's a small niche, and that's exactly the point. On this episode of Clinic Chats, Teresa shares how she built a private practice around a specialty most SLPs don't touch, why she chose to stay private pay, and how she's navigating the telepractice question that every practice owner faced in 2020.
Setting Up the Business Before You Need It
Teresa's approach to startup logistics was unusual. She separated the legal formation from the clinical launch by about two years, treating them as distinct phases. During that gap, she kept working full time at an early intervention program for kids with hearing loss and a second agency in the same specialty.
Her advice for anyone thinking about starting out? Find someone further along and copy what worked for them. She found a mentor whose practice was thriving, asked every question she could think of, and followed the same playbook. That mentorship gave her confidence even when she didn't fully understand the business side yet.
"I didn't know enough to have all that fear and those questions. So I just kind of went for it."
The basics she covered early: forming an LLC, getting an EIN online (free and fast), and setting up a CAQH profile even though she wasn't planning to take insurance. She figured she'd rather have it and not need it than scramble later if she changed her mind. Years later, she still reattests every few months just to keep the option open.
Why Private Pay Works for a Small Niche
Teresa has been private pay from the start, and it fits her practice model well. With about 10 billable hours per week, four young kids at home, and a solo operation, the simplicity of cash and check (and later, an electronic medical records system for scheduling and payment processing) keeps the administrative burden manageable.
She started tracking everything on a spreadsheet. When she moved into an office, she switched to an EMR, and the biggest benefit wasn't documentation. It was payment collection. Families log in and pay through the system, and some have set up automatic payments. No more chasing people down.
"It takes the ownership off of me. I don't have to chase people asking for money."
She still handles her own accounting, though she's quick to recommend hiring out if finances aren't your strength. For 10 hours a week of billable time, she can manage it. But she knows that won't scale forever.
The Shared Suite Setup That Fights Isolation
Private practice can be lonely when it's just you. Teresa found a solution that a lot of solo practitioners overlook: renting an office within a shared professional suite. Her space sits alongside five other offices, mostly mental health professionals, with a common waiting room and kitchenette.
Nobody's in competition. Nobody's managing each other. But there's enough foot traffic and casual conversation to make the workday feel less isolated. It's a setup that gives you the benefits of a professional office address and a built-in community without the overhead of leasing an entire space.
With her lease coming up for renewal right as the 2020 quarantine hit, Teresa was facing a real question about whether to keep the space. Telepractice was working well for many of her families. Some were driving up to an hour for sessions and suddenly didn't have to. The convenience was hard to argue with.
Telepractice, Lease Decisions, and the Future of a Niche Practice
The shift to telepractice in 2020 forced every practice owner to rethink their setup. For Teresa, it was especially relevant because her families already traveled significant distances for a specialist they couldn't find closer to home. Remote sessions eliminated that commute overnight.
She was building a survey to send to families, trying to gauge what they'd actually want in the fall. Some loved the convenience. Others missed the in-person connection. And Teresa was trying to figure out whether she could justify renewing a lease when the model underneath was shifting.
"It will be really interesting to see how telepractice affects the future of my business and my footprint and what families I'm able to work with."
She was also thinking about growth. As her own kids got older, she planned to take on more hours. But the classic scheduling conflict loomed: school-age clients want after-school slots, which are exactly the hours her own kids would need her. Her solution? Eventually bring on a contractor or employee whose availability covers those gaps, or pick up contracts with school districts to fill daytime hours while keeping evenings free.
Free Resources Most Practice Owners Don't Know About
Teresa closed with advice that had nothing to do with clinical skills. She pointed to three free resources that helped her build the business side of Sound Speech:
The Small Business Development Center at her local community college offered free mentorship, workshops, and even access to legal consultations. SCORE (score.org) connected her with mentors for one-time or ongoing guidance on everything from business structure to digital product creation. And her local library's small business department helped her with website setup, marketing, and more.
All free. All underused by practice owners who assume business support means hiring a consultant.
Her one caveat: don't let research become a substitute for action. She's an information seeker by nature and knows the trap of consuming advice instead of making decisions. The best thing she ever did was just start, imperfect paperwork and all.
"If you keep waiting, it will never happen. So just go for it."
Running a private practice solo means wearing every hat. ClinicNote is a HIPAA-compliant EMR built for private practices and university clinics, handling documentation, scheduling, and billing in one place so you can spend more time with the families 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 Jackstatt, and thank you for joining me today.
Kadie: For all of our podcast listeners, I want to welcome Teresa Harp today. She has a private practice called Sound Speech, which is in New Jersey. Hi Teresa. Welcome to the podcast.
Teresa: Hi. And thank you so much for having me.
Kadie: I'm excited that I get to hear all about your private practice journey on the Clinic Chats podcast and curious to hear exactly when you got started.
Teresa: Well, I established the business and kind of did all of that legwork with paperwork and stuff like that back in 2000, probably it was 2013, just so that when the time came and it was ready and when I was ready and when it made sense for me in my life, I could kind of get started and I wouldn't have to wait for paperwork to be processed and that sort of thing. So technically the business was formed in 2013, but I started up in terms of actually seeing clients in 2015. So there's a little bit of a gap there.
Kadie: Well, I actually really find that intriguing because yes, I feel like normally someone has to wrap their head around, okay, I'm going to get started before they really pursue anything, but I feel like you kind of did it right because that paperwork can feel like a lot and just getting that done before the stress of getting clients sounds like a great idea.
Teresa: Yeah. It worked well for me. I know for certain people it might not be the best way to go about it, but I kind of had, I knew that this was what I wanted to do. And so I just sort of took a leap of faith and hoped that everything that, the way that I was setting up the structure of the business would ultimately meet my needs and it worked out. So I was able to establish it as an LLC and had some support with getting up and started with all that type of paperwork and the legalities and stuff like that.
Teresa: And to be honest, I think that was what, eight years ago? So seven, eight years ago. And so at that point in my life and in my career, I probably didn't even know a whole lot about what I was doing, which I think was a good thing. I knew what I was doing as a speech pathologist, but I didn't know a whole lot about what I was doing in terms of starting a business. And so it just sort of took out, I didn't know enough to have all that fear and those questions. So I just kind of went for it and then when the time was right, I was able to get going and roll up my sleeves.
Kadie: Exactly. I think I was the same way. It's like it was probably beneficial to not know, just blindly walk, because if I would have had a big checklist in front of me, it would have been very overwhelming. But it was like, I'm going to take one step at a time and see where that leads me to the next step I need to take.
Teresa: Right. Right.
Kadie: So since you kind of did that business paperwork first, maybe, I've been wanting to brainstorm with someone. Not that they have to go in sequential order, but just a quick snapshot of everything you need to do. So first, you said you're an LLC. So overall, we have to decide what kind of model you're approaching in that regard. Sole proprietor, LLC.
Teresa: Right. An S Corp. I think my biggest piece of advice would be for people starting out would be to find somebody, this was what worked well for me. To find somebody who was further along in their journey and had done it, and was willing to answer any questions that I had, and I knew that it worked. What I'm saying is I knew that she had established her business, and she had a strong foundation, and that her business was thriving. So I was like, tell me what you did, and I'm going to do what you did. That was a huge help for me.
Teresa: So that would be my biggest piece of advice would be for someone who is starting out would be to look for someone who's further along, or for someone who is where you want to be.
Kadie: Yes. And then for tax purposes, right, we need an EIN. You need a tax ID or an EIN.
Teresa: And I believe that was actually, this is a long ways back, so I don't remember a whole lot about the process. And like I said, I didn't really understand enough of the process to really know exactly what I was doing, but I do remember that part being pretty simple. I was able to get that online. I think it was free, and it was quick. And so I remember that being an easy part was getting the EIN.
Teresa: And now I don't take insurance, I'm private pay, but I do have what's called a CAQH. So for anyone who is taking insurance, you'd want to be enrolled in that database as well so that you have an identification number for that.
Kadie: I'm curious, how come you have a CAQH if you are private pay?
Teresa: I actually started out working at a private practice when I first started my career. And so I got set up with a CAQH through them. And so that's the only reason why I even knew what it was. And I didn't know at that point in time when I was setting up my business if I was going to ultimately want to take insurance. And so I just wanted to be prepared.
Teresa: So I went through that process and applied and received my identification. And I still have it, and I still maintain my certification through that database as well. I reattest every, I think you have to reattest every four months, it's three or four months. So I just keep doing that just in case there ever comes a point in time when I do want to take insurance, then I've got that already crossed off my list.
Kadie: Right. So, gosh, besides the whole insurance world, I think those are the biggies besides probably insurance, right?
Teresa: Yeah, which that's a huge beast that I can't really speak to at this point because I have, like I said, started out as private pay. And that's been working well for me. My practice is small. It's just myself and I have four young kids at home. So it's not a full-time job for me.
Kadie: What about practice insurance or is it your normal SLP licensure insurance that you've carried?
Teresa: Oh, yeah. So I did go through and increase my coverage for general liability when I started my, when I opened up my office space. Because up until that point, I had been seeing families, just a few families out of my home. But once I opened up my brick and mortar, I wanted to make sure that I had that coverage. So I went through Marsh and set up my coverage for general liability. And I just followed the guidelines of the owner of the building and the landlord in terms of what kind of coverage we needed so that I knew that I would be protected and that they would be protected.
Kadie: Yes. And so you mentioned having your office space. Are you a single room space then since it's just yourself?
Teresa: You know, it's a little bit of a unique situation. I'm in a professional building and then my office itself is located within a suite. So there are five other offices within my suite as well as a waiting room and a kitchenette. And each of the renters in those offices are sole proprietors doing their own thing. Most of them are mental health professionals. And so we all just sort of share that common area.
Teresa: And that's been a really nice, I think, a really nice setup for me because private practice can be very lonely, especially if it's just you. But I have other people that are in and out of the suite. Obviously right now when we're having this conversation, we're under quarantine here in New Jersey. So no one's there. But in general, in normal times, that's how it's been. It's been nice to have that hustle and bustle but still be able to kind of do your own thing at the same time.
Kadie: Yes. That's so funny. That is exactly the setup that I had when I was in business. And it is nice to have someone to talk to but yet you're not directly working with them, which is nice sometimes.
Teresa: Yes. Or in competition with them or anything. So it takes a lot of the pressure off. And yes, it's a good scenario for me.
Kadie: Yes. And you mentioned your business name. I'm curious, how did you develop a name, a logo? How did you advertise whenever you were first starting out?
Teresa: So the name and the logo were once I had that paperwork done and I knew what I wanted my name to be. So I guess I should back up. I treat only children with hearing loss and that's my area of specialty. So for me, I wanted to think about something that was very clear to my audience or clear to customers in terms of, hey, I'm a speech therapist. So I wanted personally the name speech in there.
Teresa: And because all of the kids that I treat are deaf and hard of hearing, we work a lot obviously on sound, sound processing and understanding, sound discrimination, sound comprehension, all of that. And so that to me was a really nice way to incorporate both aspects, the hearing piece and the language piece all in one.
Kadie: Yes. And I love that you have found your specialty. How have you been able to reach out to the community and get that across?
Teresa: That is an area of, I don't want to say challenge, but it's just an ongoing area that you have to constantly prime, I guess. You have to sort of go back in and continue to keep those connections. So for me, I worked at the time when I was establishing the business, I was working full time for early intervention program for kids with hearing loss. And in addition to that, I also worked part time with another agency that specialized in hearing loss.
Teresa: And during my five or so years with both of those programs, I made a lot of good connections and formed a lot of strong relationships. And so those were really big for me when I started out on my own in terms of trying to help people become aware of who I was and where I was and what I could offer for families. So those connections have continued to be really, really critical for me.
Teresa: And then really word of mouth has been my biggest, I guess, marketing success. Just trying to build a community within the families that I serve and trying to continue to serve them and go above and beyond and hope that those families are talking with other families. And that seems to be the way that it is. I'll get new referrals from families that are connected to families that I've already been treating.
Kadie: Yes. Word of mouth is so important. Do you feel that the community has the, oh, I guess just the population that you need?
Teresa: People definitely come from all over. So I have families that will travel up to maybe an hour for services. And that I think is because, in large part, because it is such a small niche and there aren't a whole lot of speech therapists in my area that are serving this population. So families are willing to travel.
Teresa: And now, of course, with telepractice taking place, it will be really interesting to see how that affects the future of my business and my footprint and what families I'm able to work with, really.
Kadie: Right. It'll be interesting. Are families who were traveling an hour, are they going to say, you know what? We want to cut down on the time on the road. We like this.
Teresa: Right. Right. I definitely, I've actually been creating a poll that I'm going to send out to families in the next, probably in the next week, just to kind of get a feel for what they're thinking and how they envision the fall, because a lot of families are really liking this.
Kadie: Yeah. It seems like it could be a great fit, but then it's like, okay, well, will every family look different? Where some will want to check in with you once a month or every couple months. And then is it worth renting a space? There's a lot of decisions.
Teresa: Oh, you're reading my mind. Yeah. There's a lot to think about. There is a lot to think about, especially because my lease is up in just a couple of weeks. And so I'm trying to figure out what I want to do with my office space and what makes the most sense because I love my space and I love having, I love having that for families to go to and for myself to go and work and kind of get a break from the family life and a little change of pace. But at the same time, it's hard to know if I can really justify that need and that cost over the next year.
Kadie: Right. So we'll have to see.
Teresa: Yeah.
Kadie: And if people do want to come see you, would you consider seeing them in your home or is that awkward for everyone?
Teresa: I guess it just so much. Yeah, exactly. I think for me, that definitely would not work these days with four children. Yeah. It's hard to be young. So it would be tough. But when I started out, that was a great option for me because I guess I started right after I had twins and right after they were, not right after they were born, but they were like six months or so. And so my husband could just kind of take the kids out for a drive and I would just see one or two kids at a time and that was a nice way to ease my way in. But now there's four of them and it's just too much.
Kadie: Yes. How old are they all now?
Teresa: So the twins are four and I have a two-year-old and I have a seven-month-old today, actually. He's seven months.
Kadie: Oh my goodness. You're a super mom.
Teresa: I don't know. We're just in survival mode. That's just, we just take it one day at a time.
Kadie: Oh, I feel that. Yeah. But you know what? They take up all of your time no matter how many kids you have. So it's, you know, it's a struggle no matter what, but we're lucky.
Teresa: Yes. Very lucky. You're right.
Kadie: So in regards to the business, I'm curious on, you know, how the private pay structure has looked for you. Do you just simply take cash and check? Do you have any sort of credit card process or what have you done?
Teresa: I started out just cash and check and I would track everything on my own through a spreadsheet. And then as I started growing, when I moved to my office space, that's when I switched over to an electronic medical records system. So that has worked well for me. I'm not at all tech savvy and I really only use it for scheduling and for processing payments.
Teresa: And so it takes the, I guess, ownership, almost like the ownership off of me because basically I don't have to chase people asking for money. They know that they just log into the system and they can make payments that way. And we also have the option of electronic or automatic payments, which some of the families have opted for as well. So it was a lot less for me to actually have to track.
Kadie: Yes, that's great. Definitely seems to make your life easier then.
Teresa: Yes, it does.
Kadie: And I'm sure, do you do your own accounting or have you hired out as far as just tracking your income and expenses and making those quarterly payments? Are you able to do that much?
Teresa: Yes, I've been able to do it on my own. I really only see about 10, I have 10 billable hours a week. So for me, I'm able to manage that, the accounting side of things on my own. And I think long term as I grow, I would hire out for that. And I think for people who just are not good at finances or not good at keeping track of those things or it's overwhelming, I would also strongly encourage hiring an accountant. Just hire.
Kadie: Yeah. Yeah, it's just so much easier.
Teresa: I'm a control freak and I like to know what is coming in and what's going out. But I do think at some point I will turn the reins over to somebody else for that because one less thing for me to have to do.
Kadie: And it sounds like you have a really nice work balance as far as family and client hours and the business side of things. But do you foresee yourself as your own children get older, putting more time or hours into direct hours?
Teresa: Yeah, I do. I hope and plan to grow over the coming years and as they start, you know, enter school. I do plan to pick up in terms of the number of hours I can see. I think one of the challenges that I foresee would be, and maybe people who are further along with older kids can attest to this, but, you know, most families that I'm treating, if their kids are school age, they want after school hours. And that's when all of the, you know, extracurriculars are happening for your own children. So I think that could be a juggle.
Kadie: I know. And even when I was in business, not even having a school age child of my own, just realizing that that was going to be a struggle was kind of eye opening to me like, oh, I should really reach out to the homeschool population or really need to focus on those pre-K years. Just things that maybe I didn't think through beforehand.
Teresa: Yes, I agree. But you know, there's other options. I'm always thinking of my options and planning ahead. And I think, you know, I always think about, okay, at some point if I get to that point and I'm seeing kids whose families want after school hours, that doesn't work well for me, but maybe I could hire. Yeah. Maybe I either take on a contractor or an employee at some point who maybe their schedule and their availability can meet those needs. So that's always an option.
Teresa: And I also think what I've started doing more of just in the past year even, is picking up contracts with school districts. So I'll go in and see kids in the school setting and provide services to their deaf and hard of hearing kids there. But I'm doing it, you know, as an independent contractor, essentially. So I'm under my own regulations, my own guidelines, and I can help set up the terms of that contract.
Kadie: Yeah, there you go. That's a great idea. So you can find some more during the daytime hours, no evenings.
Teresa: Exactly. Fill up those daytime hours.
Kadie: Yes. Well, what a nice specialty you have. What a nice work-life balance. Is there any advice that you would like to give our listeners whom I aspire to do just what you've been doing?
Teresa: Sure. My advice would be to think about and look for as many resources as you can without going into what I, you know, what we call analysis paralysis mode. Because I think if you're at least like me, you know, an information seeker, you can go out and search for a whole lot of information. And there really are a ton of resources out there. I think they might not be very well known, but there are a lot of resources out there. And so I think it's great to take advantage of those resources.
Teresa: And some of those resources that I have found really helpful, just to name a few off the top of my head, the Small Business Development Center is, we have that at our local community college. It's right down the road. They've been fantastic for free mentorship. Everything is free. They do have some paid courses that you can take as well, but they have a wealth of information for small businesses like a private practice.
Teresa: And also SCORE, SCORE.org is a great resource to use if you're starting out. And you know, if you are just starting out with the legalities of, you know, establishing your business, definitely want to consult with a lawyer. And you can do that potentially for free through the Small Business Development Center, or you can meet with someone through SCORE as well.
Teresa: So you can find a mentor and that person can be your ongoing mentor, or if you just wanted to kind of do like a one-time meeting with a mentor, you can do that for free. And they will talk about, I mean, honestly, anything that you want help with. Like for example, I was considering, and I'm in the process of creating some digital resources that I'd like to sell for families. And so I wanted to get some support with that. And I was able to sit down for free, have a meeting, talk through all my questions. And even if they didn't have all the answers, they were able to point me in the right direction.
Kadie: Nice. Yeah, that's a great new resource. I'm going to have to look them up.
Teresa: Yeah, they're fabulous. So SCORE, Small Business Development Center, and also if your library, your local library probably has a small business department within the library. And again, I've met with their mentors as well, and that's all free. I had someone meet with me to help me set up my website, help me make some changes to my website, help me with marketing. And they're a great resource to take advantage of.
Teresa: So I would definitely look at those three. And I would also just, my one caveat to all of that is, like I said, it can be a lot of information and just be really careful, and this is the trap I always get into, is I seek so many resources, seek so much information, and then I sort of get trapped because I feel like I have to keep consuming information before I can make a decision.
Teresa: But I think, I always think back to how I started, and I just did it. And that would be my biggest suggestion. If you're thinking about doing it, just do it. Just start. And you can always fix things down the road if you need to, but if you keep waiting, it will never happen. So just go for it.
Kadie: Oh, 100% agreed. Love that advice. It's great to research. I'm the opposite. I wing it way too much. So a fine in between would be great.
Teresa: Yes. Agreed.
Kadie: Well, I appreciate your time to explain your business. I'm excited that you got to share your journey, and is there anything else that you'd like to add?
Teresa: No, this was great. I just wanted to thank you for having me on because, you know, speech pathologists, we like to talk, and this was fun. So thank you so much.
Kadie: It's such a fun community. I love that we can all come together in, you know, the business world because it's not something you necessarily learn in school.
Teresa: Exactly. You're exactly right. And so I think the more we support one another, the better. So I think what you're doing is really great.
Kadie: Thank you. Thank you for joining me and listening to Clinic Chats. 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.