When Doing It Right Means Doing It Yourself: One SLP's Path to a Stuttering-Focused Practice
Sometimes the push to start your own practice isn't ambition. It's frustration. Jessica Hudson didn't leave her position at a large multi-discipline clinic because she wanted to be a business owner. She left because she kept seeing things done wrong, and she couldn't put her name next to that anymore. Three and a half years later, she runs Stuttering and Speech Therapy of Arizona out of a 1,200-square-foot clinic in Mesa with two additional therapists, an office coordinator, and a caseload that keeps growing so fast she's moved locations three times.
Ethics Shouldn't Be Optional (But Sometimes They Feel That Way)
Jessica's story starts where a lot of private practice stories start: working for someone else and realizing you'd do it differently. At a large clinic offering OT, PT, and speech, she learned a ton from her interdisciplinary colleagues. But she also watched corners get cut. Therapists weren't treated well. And some things, she says plainly, "weren't being done ethically."
"I'm a rule follower," Jessica told Kadie. "I have to make sure that everything is legal and HIPAA compliant and that we're doing things ethically for clients because these are people's lives."
That conviction became her catalyst. She wanted a practice where her name stood for something, where HIPAA-compliant processes weren't just a checkbox but a baseline. So she built one.
Why Stuttering Isn't Just About Speech
Jessica didn't plan on becoming an SLP. She started with a business degree, hated it (which is ironic, given where she ended up), bounced through several jobs, and only discovered speech pathology through her younger sister. But once she met a grad school professor who specialized in stuttering and ran her own practice, everything clicked.
What draws her to stuttering is its complexity. Every person's journey with it looks different, and treatment goes far beyond motor speech work. For older children and adults, she incorporates cognitive behavioral approaches, addressing anxiety, avoidance, and the emotional weight stuttering carries into everyday situations.
"Are you raising your hand in class? Are you answering the phone at work?" she asks her clients. "And if you do, how does that make you feel? Do you dread it? Are you making yourself sick?"
For younger kids, she's trained in multiple evidence-based approaches (Lidcombe and Palin PCI among them) so families have options that fit their lives. It's never one-size-fits-all.
Growing Pains: Employees, Payroll, and the 80-Hour Trap
One of the most revealing parts of the conversation is Jessica's honesty about the operational side of running a practice. She chose to hire W-2 employees rather than 1099 contractors, a decision that came with extra paperwork (workers' comp, state registrations, tax forms) but one she's made manageable with systems.
"I use QuickBooks to do payroll," she said. "Once you entered in all their tax information, every two weeks I just click a button and it is done."
She tracks her therapists' schedules and hours through ClinicNote, checking in to see how many clients they've seen. Arizona also requires paid sick time for all employees, whether part-time or full-time, so that's built into her process too.
But the bigger lesson is about knowing when you can't do it all. Jessica admits she's bad at asking for help. She'd find herself at the end of the week having worked 80 hours with a to-do list that hadn't gotten any shorter. Hiring an office coordinator in January was a turning point. Even something as simple as having someone else answer the phone freed up mental bandwidth she didn't know she was losing.
Private Pay, Pediatricians, and the Marketing Problem Nobody Talks About
Jessica runs a private pay practice, and she's refreshingly honest about why: insurance reimbursement rates in Arizona are so low they wouldn't cover operating costs. She offers super bills so clients can seek their own reimbursement, and it works well enough that she plans to stay private pay "as long as I possibly can."
Her marketing strategy? Basically Google and word of mouth. She admits she hasn't put together a real marketing plan, calling it the area where she "fails." But one pediatrician referral relationship (built simply by reaching out and saying "hey, we're here") has been a steady source of new clients. Her website, built on Weebly by her own admission from someone who's "not a tech person at all," is functional if not beautiful.
And that's actually the point worth noting. You don't need a perfect marketing machine to build a thriving speech therapy practice. You need to be good at what you do, easy to find online, and willing to show up in your community.
Just Go For It (With Some Ducks in a Row)
When asked what advice she'd give aspiring practice owners, Jessica passed along something someone told her at the very beginning: just go for it. Not recklessly, but with the understanding that you'll never have everything figured out before you start.
"Get some of your ducks in a row and then just jump and do it and you'll learn along the way," she said. "I'm still learning and I will continue to learn for years and years and years to come."
Three moves, three therapists, an office coordinator, and a specialty that few SLPs pursue. Not bad for someone who didn't even know speech pathology existed until her sister mentioned it.
Running a private practice means juggling schedules, documentation, and billing on top of actual client care. ClinicNote is the EMR built specifically for practice owners like Jessica, so you can spend less time on admin and more time doing the work that matters. See how it works.
Transcript
Kadie: You are listening to Clinic Chats, the speech therapist's private practice podcast, a podcast full of personal journeys where we will 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 Jackstadt, and this is Episode 4.
Kadie: Today I have the honor of speaking with Jessica Hudson, the owner of Stuttering and Speech Therapy of Arizona in Mesa, Arizona. Thank you for joining me today. I can't wait to hear about your own journey thus far.
Jessica: Thanks, Kadie.
Kadie: Can you start by telling us a little bit about your background in speech therapy and the journey to get to the decision to start a private practice?
Jessica: Sure. My journey is a little bit different than I think some other speech pathologists. I started out getting a business degree when I was straight out of high school, and I actually really disliked it, which is funny that now I own a business. But I didn't really know what I wanted to do with it. I didn't really know what I wanted to do when I grew up.
Jessica: So I had a bunch of different jobs and then I, through a roundabout way, actually through my younger sister, found that speech pathology could be a job and I didn't even know anything about it until she introduced me to it. And I went back to school to become a speech pathologist. And while I was in grad school, I met a professor who specialized in stuttering, and she had a private practice just working with people who stutter. And I fell in love with all of it, every piece of it. I thought, that's exactly what I'm supposed to do when I grow up.
Jessica: That was in Colorado, and obviously I'm now in Arizona. And when I moved to Arizona, I worked for a big clinic that had OT, PT, speech and I loved so many aspects of it because I was able to learn from the OTs and the PTs and I feel like SLPs get so much from OTs that it was such a good experience. But I knew that I couldn't really specialize in stuttering at that clinic. And there was also just some holes that I saw working there that I just felt like clients weren't getting everything they needed. So I just wanted to fill those holes and have my own clinic where I could do the very, very, very best for clients.
Kadie: Wow. And how long ago did all of that transpire for you?
Jessica: I have had Stuttering and Speech Therapy of Arizona, it's been a business for three and a half years. Just a little over three and a half years.
Kadie: Not to undermine your business that you were employed by originally, but you said maybe some holes. Do you just mean, was it a relatively large practice where you wanted to provide something more personal or what exactly do you mean by holes?
Jessica: Sure. So it was a really large clinic. They have in-clinic services and then in-home services as well. And it's just a lot of therapists to manage. And I think that once you have so many people, sometimes things can get a little lost and therapists aren't treated as well as they should be. And another thing that I saw was just that some things weren't being done ethically. And I am a rule follower. So I have to make sure that everything is legal and HIPAA compliant and that we're doing things ethically for clients because these are people's lives.
Kadie: Absolutely.
Jessica: I just didn't see all the rules being followed. So I was wanting to make sure that I worked in a practice and that my name was associated with a practice that followed the rules.
Kadie: Exactly. Especially like you said, your name is tied to it as well. So now you have Stuttering and Speech Therapy of Arizona. You've been up and running for over three years. Tell me a little bit about your practice.
Jessica: Sure. So it's myself who specializes in stuttering, obviously. And then I have two other therapists and they do everything else. So they will see clients who stutter, but they really work with the full kind of traditional, I guess, things that SLPs would do. So articulation and language disorders, a little bit of reading, a little bit of feeding therapy. And we do see kids, infants through adults. We see a wide range of ages as well. And then I work with young kids who stutter all the way through adults who stutter. And I have a couple of kids with other diagnoses as well, but mostly I focus on stuttering.
Kadie: And where do you think the passion for stuttering began? I know you said that's what you saw whenever you were back in grad school and it just stuck out to you. Was there any other factor in deciding that's the route you wanted to specialize in?
Jessica: I really don't know. I think it sounds sort of cheesy, but I think it's just what I was meant to do. I was drawn to the complexity of it and how every stutter is so different, how every person's journey with stuttering is so different. And I also really enjoyed the counseling aspect of it because it's not just the way that a person speaks, but also how it's impacting their lives every day and how they feel about it. And to me, that's so fascinating and being able to work with somebody on those pieces is really cool.
Kadie: Obviously every case is so different. But in general, what is your theory behind stuttering or what's the treatment approach that you find yourself using the most?
Jessica: I think it really depends on what age group you're looking at because a preschooler is going to be completely different than an adult. So when I work with older children through adulthood, it's got to be a combination of, like I said, not only working on the speech and the motor piece but really diving into how is this impacting your everyday. So are you raising your hand in class, are you answering the phone at work, and if you do answer the phone at work, how does that make you feel, do you dread it. Are you making yourself sick? Are you not sleeping at night because of being so stressed about stuttering? So there's a lot of cognitive behavioral types of therapy that goes into it, working on anxiety, that kind of thing.
Kadie: Right.
Jessica: And so that would be for obviously an older child or an adult. And then for younger kids, it's a whole different story. And I think for everybody, even for younger kids, it's still not a one size fits all. So I'm trained in a couple of different types of therapies like Lidcombe and the Palin PCI so that the families have options and it's what best fits their lives.
Kadie: Exactly. Stuttering definitely is a whole other beast.
Jessica: Oh man, it's so complex.
Kadie: But it is fascinating. And just to get a grasp on not only are there things that you can teach the child, but also finding that emotional counseling aspect is just really fascinating to me. As far as the business side of things, about how many clients do you see per week? And same question for your employed therapists.
Jessica: Yeah, so I've actually been trying to decrease my caseload a little bit and increase theirs so that I could spend more time on the business. Because when I first started, of course, I did everything myself. And I all of a sudden had a caseload of 25 to 30 people and was also trying to run the business and was also trying to hire people. And it was just too much.
Jessica: So right now, I feel like I'm at a pretty good spot. I see about 15 to 20 clients a week, depending on who's on vacation or who's sick. And then between the other two therapists right now, they see about 10 to 15 clients combined between the two of them. But I'm really hoping to kind of bump them up to see a few more as well now that the school year started.
Kadie: Do you have a rental space or multiple rooms that you rent or what does that look like for you?
Jessica: Well, I've been in business for three years and I have moved three times. So, oh my gosh, I just keep growing, which is amazing and wonderful. And of course, what you hope for, but I keep outgrowing my space.
Jessica: So the place that we're in now, we moved in January and I love it. It's about 1200 square feet clinic. So we have four therapy rooms and a little waiting room with some coffee and tea, it's quite lovely. And we have our own little kitchen and our own bathroom which to me is for some reason a really luxurious thing to have, my own bathroom.
Kadie: That sounds so nice.
Jessica: Really lovely. And we're in a really nice location off of one of the highways, a main highway here. And we're right across from a little shopping center. So we try to do some therapy outside of the therapy room just to make it more realistic. So it's nice to have that shopping center so we can go across the street and go to the grocery store or Barnes and Noble or something like that and practice in real life.
Kadie: That is so nice. I love that for some generalization. As far as therapy materials, do you provide your therapist with what they'll need or is it kind of everyone's stuff combined together?
Jessica: So my therapists are employees versus 1099 contractors. And I know that every SLP who owns a private practice has differing thoughts and has differing information from maybe their CPA about what to do. Mine are employees. And so I do provide the materials for them. Rachel is one of my SLPs and she often will bring her own toys as well because she has really fun stuff, so she will bring some of her own toys but really the clinic is pretty set up for them and for myself.
Kadie: I have not gotten to talk to anyone yet who has employees versus independent contractors. So, oh, well, here I am. Tell me about that process. I don't even know what that would look like. Like you said, your CPA might've advised you to go that route. What were the steps that you had to take?
Jessica: It's actually, it seems complicated at first and it took me a little while at first to figure out everything that I needed to get together. But then once I did it once, it's so easy now because I have a list of everything that everybody needs. So you have to have workers comp in the state of Arizona. So I have to have a policy for that, which is a little extra added cost, which is not great, but part of having employees.
Jessica: And then there's just a handful of paperwork like W-2s and the state of Arizona, again, has its own form that they have to fill out for taxes. And I have to do this registration thing to make sure that they're legal to work in the state and in the United States. So there's a couple just paperwork steps, but really, truly, once you figure it out, it's not a big deal. And I use QuickBooks to do payroll. So I click a button. Once you entered in all their tax information every two weeks I just click a button and it is done. So it's really not bad once it's set up.
Kadie: That's so nice. And so for paying employee versus independent contractor, they probably have their hours on the schedule. Do you have to pay them if there's cancellations? Do you have to pay them for time off if they have benefits? Or can that look different for everyone, whether they're an employee or not?
Jessica: I think it would probably look differently, different for everybody. And then I think it also would depend on which state you're in. The state of Arizona just passed a rule a couple of years ago where we're required to pay sick time, whether you're part-time or full-time. And so I have to pay out a certain amount of sick time for employees, whether they're sick or not. So at some point I have to pay it to them.
Jessica: So that's something that I have to do. And then they have their schedule on ClinicNote and I just go into ClinicNote and check to see how many hours they worked and then they just get paid for their hourly clients. So it's very similar to how you would do it as a 1099 contractor probably.
Kadie: Right.
Jessica: And then I pay for like administrative time if we meet for a meeting or the other day we did group pictures for advertising types of things. So I paid for that time because it's out of their personal time that they're coming in to do that. So it's little stuff like that I'll pay for. But for the most part, it's pretty similar pay structure as a 1099.
Kadie: Besides the paperwork, yeah. And I'm sure, like you said, everybody could probably do it differently. I know some clinics do salary, but they're such part-time therapists that it just doesn't make sense to do them salary at this point.
Jessica: Yeah, it doesn't sound like it.
Kadie: You mentioned taking pictures for marketing materials. Tell me a little bit about what the marketing area has looked like for you and what steps have you taken to get your business name out into the public?
Jessica: Oh, gosh. To be totally honest, I fail in the area of marketing, I feel like. I have not done a lot of paid marketing. I haven't even really, to be honest, put together a good marketing plan to do marketing. I think that I've been so lucky that Google is out there and people just somehow have found me.
Jessica: But I will tell you within the last probably five to six months, I've really felt like, okay, now's the time. I think that I have the time to devote to some marketing. I see things out there that could be helpful. And so I'd like to really dive into it.
Kadie: Right. And it sounds like you've established your specialty and you have quite a full caseload. So yeah, Google and word of mouth is obviously working for you.
Jessica: Really, that's truly how people find us. We have one pediatrician who refers clients to us. And I have reached out to a couple of pediatricians at the very, very beginning, just telling them who I was. But we don't take insurance. So there's kind of a little tricky part with pediatricians. I know sometimes they like to refer to clinics that take insurance.
Kadie: Did you know this pediatrician through like family or anything, or they were just willing to listen to your services and what you had to offer?
Jessica: No, I did not know them. It was just somebody I had kind of reached out to at the beginning and said, hey, we're here and would love to network with you and be part of the community. And she's just decided that she wants to send people to us. So that's been great.
Kadie: Yeah, that's awesome. Do you have your own little brochures or pamphlets that you've handed out or do you more so have a flyer? What's that look like for you?
Jessica: When I very first started, I had a nice little brochure that I put together, but it's outdated now just because of, well, A, location has changed two more times. And it's just the information is outdated. I really need to update that and it'll be part of my marketing push here in the next couple of months because that's really where I'm going to focus my time.
Kadie: And do you have a website?
Jessica: Yeah, of course. And I do Instagram and Facebook as well. So the website is just stutteringtherapyaz.com.
Kadie: What were some of the steps to developing your website? And did you outsource that for someone else? Did you have a role in developing it?
Jessica: I still fight with it because I just put it together myself. And I am not a tech person at all. And I'm not very artistic. And so I can't really tell if things look good or bad or what. And so I just used Weebly.
Kadie: That's impressive you did it yourself.
Jessica: Yeah, but I just thank goodness for things like Weebly and Wix and Squarespace because they kind of give you this nice background or this little template that you can use and so that's helpful. But you still have to be able to manipulate that and I still will just fight with the formatting pretty constantly. My hope is that at some point, hopefully even in the near future, I could outsource and get somebody who really, that's what they do and they know to create a beautiful website because mine is okay and it's functional, but it would be really nice for somebody else to do it.
Kadie: Yeah. And as far as other therapists who might be listening, what are the different areas that you have on your website?
Jessica: I just have a little homepage that's pretty basic. And then we have an About Us page that has all the therapists and then Mel. She's the office coordinator. She's the glue that holds us all together. I love having her. So we're all on the About Us page. And then services.
Jessica: But I will tell you if other therapists are listening, I just listened to another podcast the other day and they suggested having kind of a services landing page but then having all those services as either clickable items or like a separate page so that you could really go into more detail about articulation or stuttering or expressive language, whatever it is. So mine is not like that right now, but hopefully I can get that to that point. And then, of course, a contact us page. And then I have a specific page just for stuttering as well. Oh, and then an FAQ page so that people, because it seems like we get the same questions over and over. So I have that on there too.
Kadie: Yeah, that's super useful. You mentioned that you are private pay. Is that a plan that you want to continue moving forward or are you looking to accept insurances in the future or not exactly something you want to take on?
Jessica: I would say that I'm going to be private pay as long as I can possibly stay that way. I keep, I do go back and forth and back and forth on this, the insurance thing. And I think, man, we would have so many more clients if we took insurance. But the problem is it's not about how many clients you have. It's about the revenue coming in and we wouldn't be able to pay for anything if we took insurance because of the reimbursement rates and just being so low.
Kadie: Is it fairly low in Arizona as well?
Jessica: Yeah, and it depends, of course, on the insurance you take too. The one that I would possibly consider would be Blue Cross Blue Shields. They seem to be pretty good out here, but I'm going to stick it out as long as I possibly can. It makes life a little bit easier.
Kadie: Yes, for sure. And we do super bills. So we'll create a little statement for everybody that wants it and then they can submit it to their insurance. We have a couple of clients that that works really well for and they have no problems doing that.
Jessica: Right. We still have to do some sort of billing type of thing, but it's much more simplified. You're getting paid and then they can go out and seek reimbursement with your documentation.
Kadie: Yes, exactly. Just a couple more questions. You mentioned that you have an office personnel. When did you bring her on board? And tell me a little bit about her roles and responsibilities that are helpful to you.
Jessica: So I actually think one of the hardest things for me in business is knowing when to get help because I feel like I can do it all myself. And then I realize it's the end of the week and I've worked 80 hours and I still have a huge to-do list and it's like, no, okay, wake up. You cannot do this all yourself.
Jessica: So yeah, I hired her in January of this year and it has just been so helpful to simply have somebody else answer the phone. She works mostly from her home and then she'll come into the office here and there but she doesn't just come and sit in the office, she'll just have the phone with her and then when it rings she answers it and then she does some stuff at home.
Kadie: Oh that's so nice. Do you have to pay her hourly for any time she's waiting for a phone call or how does that look?
Jessica: She has a little app on the phone so she can log in when she takes calls. It's like clocking in and clocking out. And so she'll just clock in and clock out and it logs, maybe she was on the phone two minutes. And so it'll log that time and it just adds it up. So she's not paid when she's not answering the phone.
Kadie: What is that app called that you guys use?
Jessica: It's free and it is called Open Time Clock. It's kind of old school looking and very basic but it's free. I prefer to have things very simple. I'm not very good at technology.
Kadie: I imagine that takes a lot of pressure off of you kind of being the middleman for scheduling with other therapists. That's a lot of extra communication that you have to do with families. Sounds like things are going super well for you guys. I love that you have your little niche in stuttering therapy as well as treating all sorts of populations from pediatric to adulthood. If you were to tell an aspiring private practice owner any words of encouragement, what would that be?
Jessica: I think I would probably pass on something that somebody told me at the very beginning, and that would be just go for it. It's so scary, and I'm a person who likes to have all my ducks in a row, but sometimes you can't have that and you just have to go for it. Get some of your ducks in a row and then just jump and do it and you'll learn along the way. I'm still learning and I will continue to learn for years and years and years to come. So take the risk and do it because it's mostly worth it. There's a few days where I think, what am I doing? But for the most part, it's so worth it.
Kadie: It all sounds like it's going super well. So thank you for coming and kind of filling us in on what's working for your practice. That's all we have time for. So thank you for listening to Clinic Chats, the Speech Therapist 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 personal journey through private practice, please email me at kadie at clinicnote.com. That's K-A-I-D-E at clinicnote.com.