From One Client to Ten Therapists: Gabrielle Nicolette on Scaling a Fully Itinerant Speech Practice
"Turns out I'm now taking private clients." That's what Gabrielle Nicolette told a family who couldn't find a speech therapist for their child. She hadn't exactly planned to launch a private practice. She just said yes to a family who lived near her house, and then she couldn't stop saying yes.
Ten years later, Speech Kids has grown to ten therapists serving families across the Washington, D.C. area. No brick-and-mortar office. No insurance contracts. Just clinicians driving from home to home, working with kids where they live, learn, and play. It's a model that creates freedom and flexibility, but also some real operational headaches that Gabrielle is still figuring out in real time.
Growth That Didn't Wait for a Business Plan
Gabrielle didn't start Speech Kids with a logo, a website, or an LLC. She started with a clinical fellowship at a Maryland school for kids with complex needs, where she worked alongside twelve other speech therapists and found her niche with younger children.
After maternity leave, she transitioned into an outreach program that took her into preschools for functional evaluations. That's where she started meeting families directly. And when one family couldn't find services anywhere else, she stepped in.
"I had no idea what I was doing in terms of the business side of things when I started. I was a clinician who was full and needed a solution to that problem."
That solution was hiring. First one therapist to see the overflow. Then another. Then another. The growth was completely organic, fueled by referral partners, word of mouth, and Gabrielle's growing reputation as the person to call for complicated kids, especially late talkers.
For a long time, she was sending invoices in Word and running every piece of the business herself. The formal structures, a practice name, a billing process, an office manager, came years later.
The Real Math Behind an Itinerant Model
Running a fully mobile practice means zero overhead for office space. But it introduces a constraint that most clinic-based owners never think about: drive time eats income.
A therapist who sees a 9:00 a.m. client can't take a 10:00 a.m. unless the next family lives on the same block. In D.C. traffic, that's rare. So a realistic next slot is 10:15 or 10:30, which automatically limits the number of clients each therapist can see in a day, which limits what they can earn.
"What begins as a low overhead proposition sometimes ends up as a not viable solution for some therapists who would like to work for me and who can't because they can't make the numbers work."
Gabrielle has tried different compensation models. Most of her team are independent contractors who set their own schedules and may also run their own practices on the side. She's experimented with hourly employees too, which lowers the per-session rate but gives her more scheduling flexibility. She hasn't landed on the perfect formula yet, and she's honest about it.
"I still haven't figured out what the right mix is for the practice," she says. "I have to think about the practice. But I want my people to be happy because then they stay."
No Non-Compete, But Clear Boundaries
Scaling to ten therapists in a major metro area means navigating contractor relationships carefully. Gabrielle learned this the hard way when a therapist left and took clients with her. It stung, both personally and financially.
Her solution wasn't a non-compete. In a densely populated market like D.C., she says those are virtually impossible to enforce and unfair to clinicians. Instead, she uses a restrictive covenant: if you leave Speech Kids, the clients stay with Speech Kids.
Beyond that, she's genuinely supportive of therapists who also run their own practices. Some of her team members see a few Speech Kids clients in the evenings or on weekends while holding school jobs or building their own caseloads during the day. That flexibility is part of the appeal.
"That's what I love about this profession," Gabrielle says. "You get to decide what it is that you want."
The Parent Education Gap Between School and Private Therapy
One of the more nuanced parts of Gabrielle's work is helping parents understand the difference between what school-based speech-language pathology services can do and what private therapy can do. They're different mandates with different criteria, and that disconnect creates a lot of frustration for families.
She regularly sees kids who didn't qualify for school services but clearly need support. Rather than letting parents stay angry at the school system, she reframes it.
"You're right, the school system is right not to give your child services. I understand why they didn't. That's not to say your kid doesn't need it or wouldn't benefit from it. But they have their criteria."
That kind of parent education matters. It builds trust, sets realistic expectations, and positions the private therapist as a collaborative partner rather than a competitor to the school SLP. It also helps families make informed decisions about where to invest their time, energy, and therapy documentation efforts.
Gabrielle has taken this educational approach even further with a program called Toddler Talk, an online video course for parents of toddlers. It's built on the indirect therapy strategies she uses with her own clients, things like predictable bedtime routines and communication systems, packaged for any parent who wants a little more ease in daily life. She ran it as a live class first with weekly Zoom calls, then wrapped it into a self-paced format available on her website.
Get a Coach Before You Think You Need One
When asked for advice, Gabrielle doesn't talk about marketing tactics or insurance panels. She says: get a coach.
"We've got our therapeutic skills, we've got our hearts, but I did not start off knowing how to systematize a hiring process, for example, or to write an operations manual."
She started working with a business coach a couple of years ago to grow more strategically, and it changed how she thinks about the practice. Things like hiring workflows, operations manuals, and revenue diversification. The clinical skills got her to ten therapists. The business skills are what will keep them.
When your practice grows beyond just you, the admin load grows with it. ClinicNote is a HIPAA-compliant EMR built for private practices and university clinics, keeping documentation, scheduling, and billing in one place so you can focus on the families and the team you're building. See how ClinicNote works.
Transcript
Kadie: You are listening to Clinic Chats, the speech therapist 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: The owner of Speech Kids, Gabrielle Nicolette, is on the podcast with me today. Hi, Gabrielle.
Gabrielle: Hey, Kadie. Thanks for having me.
Kadie: I'm so happy that you are willing and able to join me today on the podcast because in reviewing the Speech Kids website, I did find a few unique aspects to the business that I think our listeners will be curious about. So can you start maybe from the beginning, how you got into private practice, and then tell us where it led to your business today?
Gabrielle: Absolutely. So when I graduated from the University of Maryland, I went and did my CF at a school in Maryland for kids with special needs. It was a class five private school for 200 of the very most complicated kids you might ever meet. And so that was kind of an awesome place to just learn about the craft, because as you know, this is a mileage sport, and to sort of figure out what I wanted to do. Did I want to be with the younger kids? I had some middle school kids. I didn't really like those. I liked the younger ones. I had kids who had on-com devices. I had kids who were nonverbal. I had kids who were very verbal. So I got to see a lot of really good stuff, and I had access to some really cool other speech pathologists, because we were a staff of, I think at the time there were like 12 speech pathologists on the staff.
Gabrielle: So that was just a great place to be, and I stayed there for five, six years. In between sort of maternity leaves, I had two kids in the process. And then when I had my daughter, I decided that I didn't want that school grind. And even though it was a private school, and they were low caseloads because they were such high needs kids, I just decided I was ready for a switch.
Gabrielle: And so there was an outreach program as part of the school where I was working that was going into preschools and doing these observations, and like sort of partway between evaluations and screenings, where kids would get identified as, you know, something's going on here, but we don't know what it is. And so we would go in and do these sort of functional evaluations in preschools. And that's how I sort of got out of a school setting and into a functional environment.
Gabrielle: And then one day there was a family, and I had referred the little guy for speech because he was probably on the autism spectrum, and they couldn't find a speech therapist. They called all of the people I referred them to, and they came back to me and said, we couldn't find anybody. Nobody has availability. And they lived really close to my house. And it was just at the time when I was starting to think about taking private clients. And so I said, well, turns out I'm now taking private clients.
Gabrielle: So I started with one. And then, you know, pretty soon I was full. My schedule was packed. And so I hired somebody to see the overflow. And then she was full. And then we hired somebody else to see her overflow.
Kadie: Oh, my goodness. So did it all just happen very naturally because you were making referrals?
Gabrielle: Yeah, I mean, because I had worked in this local school, and then I was keeping my practice local. And so I started to get to know the referral partners, the people who were going to think of me when they came across a kiddo. And then I also have a really strong, and I have always had a really strong interest in very young children, late talkers in particular. And so that was something that I started to be known for, like, oh, you've got a complicated kiddo. Call Gabrielle. She knows what to do.
Gabrielle: So yeah, it was super organic, honestly. Like I had no idea what I was doing in terms of the business side of things when I started. I was a clinician who, you know, was full and needed a solution to that problem.
Kadie: Yeah, I mean, that's a great problem to have. It seems like it really just happened naturally and quickly evolved. So as you got more and more private clients, was it kind of after the fact that you thought, okay, I need a business name and I need to kind of get my ducks in a row?
Gabrielle: Absolutely, yes. For a long time, you know, I was sending invoices using Word. And I did not have a bookkeeper. I did not have, I didn't have anybody, I had myself. All of those kind of business-y structures came about much, much later. And so, you know, fast forward, we've now been Speech Kids for 10 years. But that was after I had hired three people.
Kadie: Right. So do you still have three people under you today?
Gabrielle: So we are now 10 therapists.
Kadie: Oh my goodness.
Gabrielle: Yeah. And we see clients all over the Washington, D.C. area. You know, and when I say 10 therapists, these are, some of them are just working for me. Some of them have their own private practice that they're nurturing and they also see clients for Speech Kids. You know, a couple of them, I have a therapist who's, of course, going on maternity leave this year. And so people are in different places. Some have school jobs during the day and see a couple of kiddos for Speech Kids in the evening or on a weekend. So it's a real mix, which is kind of what I love, right, about this profession is you get to decide what it is that you want.
Kadie: Yes. And how you want to structure your time.
Gabrielle: Exactly.
Kadie: And it sounds like you're open and flexible to quite a wide variety. You don't have a non-compete clause. It sounds like you're supportive of someone who might be also trying to start their own thing and so they're just getting some extra hours here and there. Is that correct?
Gabrielle: Yes. I have been burned in the past by somebody who left the practice and the clients ended up following that person. And so that was really hard for me, just sort of personally and business wise at the time. And so yes, there's not a non-compete, but there is a restrictive covenant. You know, when people sign up with me and I make it very clear, like you agree that if you're leaving, you're not taking anybody with you, right? You're leaving the clientele with this company.
Kadie: Exactly.
Gabrielle: But in this area in particular, and I know it's different in different areas of the country, but we're such a densely populated part of the country that it really makes no sense even for like a two mile radius. If I were going to try to impose some kind of non-compete, it's virtually impossible to enforce. And it's certainly not fair to the clinician to put that on them. So there's just a need in the area and...
Kadie: Yeah. I mean, you know what, there's plenty, there's somebody for everybody. So I can see the business model as far as going to clients' homes whenever they're young toddler age, preschool age, homeschool, whatever it may be, but tell me a little bit about what it looks like to have a school agree to bring in another therapist. Maybe it's different there. I'm in Illinois and I found that usually that was not allowed. If a student had an IEP, they did not want any outside therapist in the building.
Gabrielle: I think that that is definitely true for school age kids and certainly in the public system. So what I've been able to do in my practice, number one, is we focus very, very much on birth to five, and that's really the core of our practice, of my practice is under five-year-olds. Part of that is because that's where my interest lies. And then the other part is it's really hard to get into schools after they turn five.
Kadie: Yeah. I imagine so.
Gabrielle: I will say I actually do have therapists in a couple of public school settings, not on behalf of the school, but on behalf of the parents, and that's something that gets worked out on a case-by-case basis. It's usually up to the discretion of the principal. And so we have had opportunities to make that work, and I just find it takes, and I think this is true of any place that we are, like in daycares, we're in a couple of daycares, we're in a number of preschools in the area, I'm in a couple of big, what I call big kid private schools. It just takes open communication about this is what we want to do, this is how it's going to help the child, this is how it's going to help you at school, and getting parents to really advocate for their children to the educators.
Gabrielle: But I get it, and certainly there have been times when the school has said, no, you're not welcome here, and we make that work, because they are perfectly entitled to do that.
Kadie: Right. I think it's probably quite the balancing act, because I think the school probably doesn't necessarily mind an outsider coming in. It's probably almost driven by fear that, oh, they're getting outside therapy, is the family going to decide they don't want to pay for it, and say, well, now you need to up the child's minutes, because they're needing this. So I'm sure everybody's hands feel a little tied in this situation, and it makes it tricky.
Gabrielle: Yeah. One thing I really try to do with the parents of the kids on our caseloads is make it clear what the role of the school speech pathologist is, and what the role of the home speech pathologist is, because those are different things. And I actually have a number of kids on my caseload who went for an evaluation through the school system, and didn't qualify. And parents come to me, and they're kind of mad about it, and I say, listen, you're right, in terms of the school system is right not to give your child services. I understand why they didn't. That's not to say your kid doesn't need it or wouldn't benefit from it. But they have their criteria, and they have to abide by those, and it stinks sometimes.
Gabrielle: That's a point of parent education, for sure. What the school can do, and is allowed to do, and then what we can do, which obviously part of the reason we go into private practice, is we've got a lot more freedom.
Kadie: Yes. And so for your billing structure, do you accept insurance, or are you private pay only?
Gabrielle: I am only private pay, and part of that is because I am too, I don't know if scared is the right word, but I'm too wary of going into that whole world. It just seems like a nightmare, and I've been able to make it work so far, and so far I have not ventured down that road.
Kadie: That's amazing that you have such a large, or what it seems fairly large, practice, private pay only. Do you have to turn families away frequently, or is it not as much as I might assume?
Gabrielle: I have people that I refer out, yes, that's for sure something that happens. But the other thing is, I give them a super bill, it has all the codes on it, and so one of the things that I'm also really sort of passionate about is telling parents how to get what they want. One of the things that happens when parents call our practice, the practice manager speaks with them and tells them, okay, do you know what early intervention is? Do you know what Child Find is? Have you heard of a university clinic? She walks them through all of the things, all of the ways you can get an evaluation and therapy, and then we figure out what's right for the client.
Gabrielle: And so I always offer a referral to parents who say, well, I really do need my insurance, I really need it to be in-network, and we have not many, but a couple of practices that we refer to if they need in-network coverage. Sometimes they get reimbursed out of network, sometimes they don't. I mean, the insurance question is a big one.
Kadie: Right, right. I don't blame you from just treading lightly with a super bill and not getting any closer.
Gabrielle: Exactly.
Kadie: So you have an office manager. How long have you been able to employ someone to help manage the business side?
Gabrielle: We were trying to figure this out the other day. I think, so the business started in 2009. I think I must have hired her in 2012.
Kadie: Okay, and she's been with you the entire time?
Gabrielle: She has. Yes.
Kadie: Oh, that's so nice.
Gabrielle: No, she's fantastic. She is the mom of two former clients.
Kadie: Oh, cool.
Gabrielle: She gets it from the inside out, and she's able to give parents a really empathetic, not just sympathetic, ear when they call. I mean, I pay her, obviously, but we don't bill clients for that incoming call. And she spends a significant amount of time with them, just sort of, again, making sure they know what's going on, talking to them about their child, like, what's the struggle, what other areas are going on. She really does a phenomenal job of, you know, dealing with, we talk about the whole child. She deals with the whole parent.
Kadie: Yes, and that's so important because you're establishing that client, parent, therapist rapport from the beginning. She works, I guess, from home, probably not out of an office since you don't have a brick and mortar practice.
Gabrielle: Yeah, we are like 100% itinerant. So I'm working in my home office right now. She works in her home office. Our therapists are itinerant. So they're all over, all over the DC area at any given moment.
Kadie: How do you factor in travel for not only employees, whether they're contracted or employed, whatever? Can you explain that from a client and an employee perspective?
Gabrielle: The short answer is no. And this is something I have really been looking at because it's the right question to ask. Because we travel, there are some things that automatically happen as a result. For example, my therapist can't see a 9 a.m. and a 10 a.m. and an 11 a.m. So unless two kids are like on the same block, it's really hard to get anywhere in DC in 10 minutes. So that doesn't happen.
Gabrielle: So that means you're doing, okay, so let's say you've got a 9 o'clock, that means you can see a 10:15. That automatically cuts down the number of clients that my therapists can see, which automatically cuts down the amount of income they're able to make. And so what begins as a low overhead proposition sometimes ends up as a not viable solution for some therapists who would like to work for me and who can't because they can't make the numbers work.
Kadie: Right. And that is definitely something I struggle with as an employer. Like I want my people happy and I want them to feel like they're valued in every possible way for the work that they do. And that includes compensation.
Gabrielle: Yeah, because you're not bringing any income in when they're on the road either. So it's not like you just have these funds to pull from.
Kadie: Exactly. So it's a balancing act and it's funny you would ask me that because this week I've been like in the middle of this spreadsheet, which I hate spreadsheets, but sometimes you have to use them. I know you like spreadsheets, I hear.
Gabrielle: So that's different for you.
Kadie: Love them. Maybe you can figure out this model. I might send you this modeling that I'm doing here.
Gabrielle: There you go. Good idea. I'm looking for you here.
Kadie: Yes. Well, I imagine that eventually some sort of solution will be figured out, but these are contracted employees, so you're not having to pay for their drive time, although you're taking them into account.
Gabrielle: Yes. These are contractors. I did last couple of years ago and last year have an hourly employee. So I have sort of dabbled in that. It lowers the hourly rate a little bit for the therapist, but it means they're sort of more available to me, the employer, because they don't get, I mean, assuming they have the skills, they take the clients. Having both is kind of a pain. Again, I think I still haven't figured out what the right mix is for the practice and what the system is that works for everybody. So I have to think about the practice. But again, I want my people to be happy because then they stay.
Kadie: It's definitely tricky. And tell me a little bit about on your site, it looks like there's some parent trainings available. Can you discuss that aspect of your business?
Gabrielle: Yeah. So one of the things I noticed as I was sort of, so I'll back it up a second. A couple of years ago, I started to get some business coaching just because I wanted to grow a little bit more strategically, put some systems in place and that kind of thing. As I started to think about what it is that I'm doing in my practice when I am seeing my kids, one of the things I do a lot of, and we all do it, are these sort of, we call them indirect therapy techniques, right? It's like creating a bedtime schedule so that kiddo isn't freaking out every night at bedtime because parents are doing things differently or haven't realized that, take your pick, right? They want the green pacifier, not the red pacifier. Let's figure out what those things are that are going to get people calm and let's implement those as a system.
Gabrielle: Well, guess what? What's good for the goose is good for the gander, meaning even if you have a child who doesn't have any special needs, any speech and language needs, those are just good parenting practices. Right? A predictable bedtime and sequence just makes everybody happy, not just your nonverbal autistic, take your pick.
Gabrielle: I started to write all of those down and sort of develop a parenting program, which then became something I call Toddler Talk, which is an online video class for parents. It's a totally kick-ass class, if I do say so myself. It's full of these indirect therapy strategies, and it's for parents of toddlers who just want a little bit more ease in their lives and who maybe haven't thought about these kinds of things to the extent that we speech pathologists do because we want to make a system about everything.
Kadie: Right. Yeah. Yeah.
Gabrielle: I sort of put it all together, and I did the modules, and I ran a class last year, a live class that had some calls, and I've since sort of wrapped it up and done it as a DIY that you can access on the website.
Kadie: That is one of the ways in which you are starting to branch out, different revenue streams and that kind of thing.
Gabrielle: Very cool. So definitely not only for special needs families, also just some parenting tips, tricks, hacks, whatever you want to call it.
Kadie: Don't we all need those?
Gabrielle: Oh, yeah. For sure. Even as a speech pathologist, I need a lot of help. So are these programs for a one-time fee? How does that work?
Gabrielle: I'm still developing those. So Toddler Talk as a class is available on the website. That's like a one-off kind of thing. I am actually going to be making some changes to the website and letting people work directly with me as, you know, like in a parent coaching capacity, and so that's still getting fleshed out. Those are some changes that I need to make. But the group calls were so much fun. When I did Toddler Talk as a live class, we would meet every week on Zoom, and it was so much fun. So I'm really looking forward to doing that again sometime.
Kadie: Oh, yes. How fun. I'll have to kind of stay up to date on your website. I have a toddler, so I'm interested.
Gabrielle: Well, I will put you on the list.
Kadie: And I see you have blogs. Do you write them yourself? Do you have outsiders write for you?
Gabrielle: I write all of my blogs myself. I do the videos every week. But I do have somebody posting who's like in charge of the actual mechanics of getting it up onto the website. Because technology and me are not, we're not friends.
Kadie: Website development is just very tricky. So is this the same person that would have developed the website or no?
Gabrielle: No. The people who developed my website, I hired a firm out of Colorado to do the website, and then I've tweaked it a little bit over the past year. No, this is a virtual assistant who works for me a certain number of hours a month. And she's amazing. She also loves spreadsheets. She puts things together. And it's like, oh my God, I didn't know it could be this organized.
Kadie: I think you're underestimating yourself because you have a lot of moving parts going on. So you must be organized somehow.
Gabrielle: Some days I'm like, oh my God, really? My assistant is amazing. And she structures the social media. And so then literally all I have to do for that is do the content. So I sit down a couple times a month and we've brainstormed topics in advance. And I go in and I do the content and then do the videos. And then she puts them up on social media.
Kadie: That definitely makes things a bit easier for you. Are you still, you still see patients and have a caseload then?
Gabrielle: I do. Yeah. I do. Because the times when my caseload is too low, I'm like, my caseload is too low. I need more kids. And then I'll take lots of juicy, yummy, fun, awesome clients. And then I'll be like, oh my God, I have no time for anything else. What have I done?
Kadie: What have I done?
Gabrielle: So it's a balancing act. I'm still, you know, I think the beauty of being in private practice and the beauty of being an owner of a private practice is I get to decide. I get to change it. If I decide I'm going to take X number of clients, I get to see X number of clients. If I decide I'm going to take Z number of clients, I get to see Z number of clients. And I can dial that down and up as necessary.
Kadie: Yeah. You can say you're quote unquote full, even if you have two days a week off, you know?
Gabrielle: Yes. Although the therapist in me, the helper in me is always like, of course, I'll see you for free on the weekends. Sunday morning at 8 a.m.
Kadie: Yeah. No, I have been there in my life and that's a place where I no longer am, but I definitely have come from those tendencies for sure. And I still have those thoughts like, right, can I fit this kid in on a Saturday? Like, nope, I'm not doing that anymore.
Gabrielle: No, don't do it.
Kadie: Well, any words of advice as far as new private practice owners who are wanting this kind of growth?
Gabrielle: Yeah, get a coach. It's so worth it because, I mean, you can definitely achieve a certain level of growth on your own. And I think there are probably people who can do it on their own and run, call it a million dollar business or whatever you want to call it. Get it to a place that it's really big enough for them on their own. But I think more of us, myself in particular, just we don't have the other stuff. We've got our therapeutic skills, we've got our hearts, but I did not start off knowing how to systematize a hiring process, for example, or to write an operations manual.
Gabrielle: So there are these things that a mature business needs to have and it's just a really good idea to get some help with that so that you're not reinventing the wheel every five minutes.
Kadie: Yes, yes. I think those are really unique suggestions because of your size, I think, and because you need a lot of paperwork in place for employees and contracts and all of that fun stuff. I appreciate all of your feedback today. I loved hearing about your own personal private practice journey and I just thank you for taking the time to join me.
Gabrielle: Oh, thanks Kadie. It was a pleasure. I'm so glad that you're doing this podcast. It's really great.
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 me kadie at clinicnote.com. That's K-A-D-I-E at clinicnote.com.