Running an SLP Private Practice in More Than One State

Growing an SLP or audiology practice across a state line can start small: a family moves and wants to keep their child's therapist, a teletherapy client turns out to live next door in another state, or a second office opens near a metro area that straddles a border. Each of those is a licensing event. Authority to practice attaches to the clinician and the client's location, not to the practice, and a practice that does not track that carefully can end up billing for sessions no one was authorized to provide.

Who needs to be licensed where?

Every clinician who treats a client needs authority in the state where the client is located during the session. The ASLP Compact model law says an SLP or audiologist "must comply with the state practice laws of the state in which the client is located at the time service is provided" (Section 3.H), and state boards say the same for their own licenses. The Texas Department of Licensing and Regulation, for example: "If the clients receiving the services are located in Texas, then you must hold an appropriate Texas license."

ASHA's telepractice guidance adds that clinicians should verify licensure in both the state from which they provide services and the state where the client receives them, and that clinicians are responsible for understanding how their own location affects licensure, professional liability coverage and reimbursement. The owner's license does not cover the staff, and one clinician's privilege does not cover another.

Where do compact privileges fit for a practice?

They help only in a narrow band. As of October 2026, privileges are issued only between Louisiana, West Virginia, Ohio and Tennessee, and only to a clinician whose own home state, meaning where that clinician lives, is one of the four. A practice in Ohio with staff living in Ohio can use privileges for clients in West Virginia, Louisiana or Tennessee. A practice near the Ohio and Pennsylvania line cannot use the compact for Pennsylvania clients; Pennsylvania has only a pending bill. See which states issue privileges.

Clinicians who live in different states from the practice have different home states. An SLP who works at your Ohio clinic but lives in Kentucky has Kentucky as a home state, and Kentucky has enacted the compact but is not issuing. That person needs licenses, not privileges.

Can the practice buy privileges for its clinicians?

No. The model law makes the licensee the one who notifies the Commission and pays (Section 4.A). The Commission's Rule on Fees says the $50 administrative fee "shall be paid by the licensee." The CompactConnect attestations are first-person statements each clinician makes about their own name, residence, discipline history and investigations. Each clinician has to register, attest and pay personally. The practice can reimburse afterward; nothing in the Rule on Fees prevents that. Keep the emailed receipt for your books. See can someone else apply for my ASLP privilege?

Compact privileges also do nothing for SLPAs or clinical fellows. The Commission's FAQ says assistants are not eligible and that anyone whose role requires supervision, such as a clinical fellowship, is not eligible either. If your model relies on SLPAs or CFs, each needs a license or registration in every state where they treat, and each state's supervision rules apply. See SLPA supervision rules that trip up a move.

How does Medicare change the picture?

If you bill Medicare, three rules from CMS manuals shape a multi-state practice:

• Office location. The Program Integrity Manual says an SLP in private practice bills Medicare only for services in the practice's own office, located "in the state(s) where the therapist (and practice, if applicable) is legally authorized to furnish services," or in the patient's home.
• Enrollment and supervision. The Benefit Policy Manual says each therapist employed by a group "should enroll as a TPP," and that an unenrolled therapist's services must be directly supervised by an enrolled therapist present in the office suite.
• Assistants. The same manual says SLPA services "are not recognized for Medicare coverage," even if the assistant is licensed.

For telehealth, the CMS Telehealth FAQ (updated February 26, 2026) says SLPs and audiologists can furnish Medicare telehealth through December 31, 2027 and can no longer do so starting January 1, 2028. Commercial payers and Medicaid set their own rules. See Medicare enrollment for SLPs and audiologists and, for the payer side, group practice credentialing at White Glove Credentialing.

Which licensing setup works for a growing practice?

1. Map clients to states every week, by where they are during sessions, not their billing address.
2. Map each clinician's authority: home license, privileges and other state licenses, with expiration dates.
3. Match schedules to authority. Do not book a clinician with a client in a state where that clinician is not licensed or privileged.
4. Use privileges where they work, meaning the clinician's home state and the client's state are both among the four issuing states, and state licenses everywhere else.
5. Plan SLPA and CF coverage state by state, with supervision rules for each.
6. Check school and dispensing credentials if you contract with districts or dispense hearing aids; a privilege does not replace either where the state requires its own.
7. Re-verify on every move. A clinician who moves to a non-member state loses every privilege at once (model law Section 4.F).

What does the renewal side look like?

Privileges expire with each clinician's home license, and the Commission's FAQ says CompactConnect shows a privilege as Inactive after the home license's printed expiration date, regardless of any grace period. It recommends renewing the home license at least ten business days early. Each full state license has its own cycle and CE. Texas, for example, requires an approved human trafficking prevention training course to renew, and says there is no grace period for expired licenses. One missed date can take a clinician off the schedule in several states. See renewing ASLP privileges with your home license.

Which records should the practice keep?

• For each license: state, number, expiration date and the CE that state requires.
• For each privilege: the privilege number and receipt CompactConnect emails after purchase, and the clinician's home license expiration date it depends on.
• Jurisprudence completions for states that require them. The jurisprudence attestation says the Commission "may audit jurisprudence attestations at their discretion," so the clinician should be able to produce proof.
• Client location at each session, especially for teletherapy. ASHA's guidance flags temporary moves such as vacations and college attendance as situations to check.
• Supervision records for SLPAs and clinical fellows, in the form each state requires.

When should a clinician get a license instead of a privilege?

When the client relationship is long-term, when the clinician might move, or when the practice needs that clinician in the state regardless of their home license status. A privilege is cheaper but inherits every problem with the home license; a license stands alone. See compact privilege or a state license?

We handle licensing for practice owners and their staff. License by Endorsement is $599 per state, a Full State License Application $749 per state, SLPA License or Registration $399 per state, and Clinical Fellowship and Provisional License $349 per state. For staff in issuing states, the ASLP Compact Readiness Review ($149 one time) and the Compact Privilege Concierge ($299 for the first privilege, $149 for each additional) prepare each clinician and guide a session in which that clinician applies, attests and pays. Annual Renewal and CE Compliance ($299 per license, per year) tracks every date. Board and Commission fees are separate. See the state license index.